Effect of variation in PQ interval on patterns of atrioventricular valve motion and flow in patients with normal ventricular function.

M-mode echocardiography and Doppler ultrasonography were used to study patterns of atrioventricular (AV) valve motion and flow in five patients with complete heart block, normal ventricular function and an implanted dual chamber pacemaker with programmable PQ intervals. Changes in AV valve motion and flow patterns resulting from steady state changes in PQ interval over the range studied (75 to 250 ms) were similar in all patients. Events reflecting AV valve opening and rapid ventricular filling bore a constant temporal relation to the Q wave and were unaffected by changes in PQ interval. Events reflecting atrial contraction occurred progressively earlier in diastole with lengthening of the PQ interval, until superimposition of atrial contraction on rapid ventricular filling at a PQ interval of 250 ms. The duration of mid-diastolic slow ventricular filling and overall diastole, defined with respect to an open valve, decreased with lengthening of the PQ interval. The onset of AV valve closure (A point) bore a constant temporal relation to the P wave, indicating that atrial systole initiated valve closure. However, completion of AV valve closure occurred progressively earlier with respect to the P wave as the PQ interval was decreased. This suggests an increasing contribution of ventricular systole to completion of AV valve closure with decreasing PQ interval. End-diastolic and end-systolic ventricular and atrial dimensions were independent of the PQ interval.