Effects of respiration and posture on paroxysmal supraventricular tachycardia

The capacity of deep inspiration and the dependent body position to terminate episodes of tachycardia was studied in 11 patients with recurrent paroxysmal supraventricular tachycardia (PSVT). In eight patients, a deep inspiration and a dependent position repeatedly terminated episodes of PSVT. Reasons for failure were found in the other three patients. A deep inspiration or assumption of a dependent position dramatically raised arterial blood pressure and terminated episodes of PSVT by reflexly increasing vagal drive. The magnitude of the rise in blood pressure was directly proportional to the depth of the inspired volume and to the extent of body dependency. The upright position attenuated the respiratory-induced increase in blood pressure and blocked PSVT termination. Likewise, vagal blockade with atropine did not affect the effects of respiration or dependent position on blood pressure but prevented termination of PSVT.