Hemodynamic effects of rapid atrial stimulation in adult and young dogs

We evaluated the use of rapid atrial stimulation (RAS) to produce 2:1 atrioventricular (AV) block as a method for treating supraventricular tachycardias. We studied the cardiovascular hemodynamic changes before and after block in eight adult dogs and nine young dogs (3-4 1/2 weeks old). In each dog an electrocardiogram; cardiac index; aortic, pulmonary, and left ventricular (LV) systolic and end-diastolic pressures; and LV (dp/dt) p were recorded simultaneously and pulmonary ans systemic resistances were calculated. Measurements were obtained during (1) the control state, (2) RAS with maximal 1:1 AV conduction, (3) RAS with 2:1 AV block, and (4) RAS with 1:1 AV conduction at 50% of the rate which resulted in 2:1 AV block. Comparison of the hemodynamic effect of RAS with maximal 1:1 AV conduction and hemodynamics in the control state showed that there was a significant decrease in cardiac index and aortic mean pressure of 39% and 15%, respectively. When hemodynamic changes during RAS with 2:1 AV block were compared with those during RAS with maximal 1:1 AV conduction, cardiac index, LV systolic pressure, and aortic mean pressure increased by 52%, 17%, and 22%, respectively. LV (dp/dt) p increased by 20% and was significantly higher during RAS with 2:1 AV block than at higher ventricular rates obtained with RAS and maximal 1:1 AV conduction. We found that in this acute study the hemodynamic findings for the young dogs were similar to those for adult dogs. The data suggest that (1) significant hemodynamic improvement is obtained by RAS causing 2:1 AV block when compared to higher ventricular rates associated with 1:1 AV conduction; (2) in addition to increasing the diastolic filling period, reducing the very high ventricular rates improves the cardiac contractile state, and (3) RAS and 2:1 AV block may provide a useful technique for the management of some patients with intractable supraventricular tachycardia.