[Reversal left diastolic ventriculo-atrial flow induced by asynchronism in a patient with dilated cardiopathy and VVI...

We studied a case of reversal atrioventricular diastolic flow in a 74-year-old patient suffering from chronic heart failure for six years, following double myocardial infarction on the inferior (in 1985) and the anterior wall (in 1992). During his last hospitalization, he had an arrhythmic complication (advanced atrioventricular block) that required a definitive implantation of a VVI-pacemaker. The patient, a working man in good hemodynamic condition over the past several years, acknowledged symptoms of progressive functional decline three to six months prior to coming to our observation for a medical check-up. The surface electrocardiogram showed normal electrical PM activity. Echo-Doppler examination beyond the improved systolic function of left ventricle showed a variable E/A velocity ratio of mitral valve flow, due to the casual relationship between spontaneous atrial electrical activity and ventricular stimulation. In addition, at the surface ECG we frequently observed a retrograde atrioventricular flow during mean phase of diastole each time the P wave occurred at the end of T wave. This event did not occur when the T-P interval was longer (a few more milliseconds) and was thus similar to a normal atrioventricular ECG sequence. To summarize, we can affirm that in patients with dilated cardiomyopathy and improved systolic function requiring pacemaker implantation, the sequential mode of ventricular stimulation must be preferred, especially if there is normal electrical activity in the right atrium.