Echocardiographic features of atrioventricular and ventriculoatrial conduction.

The potential application of diagnostic ultrasound to understanding of the hemodynamic effects of various rhythm and conduction disturbances has not been fully explored. To investigate the change in cardiac function associated with various atrioventricular (A-V) sequencing intervals during cardiac pacing, simultaneous M mode and two dimensional echocardigraphic and hemodynamic studies were performed in 23 dogs. One to one A-V and ventriculoatrial (V-A) sequential pacing at cycle lengths of 400 and 300 ms revealed a stepwise reduction in left ventricular pressure and cardiac output as the A-V interval was changed from +100 to -100 ms. These reductions in cardiac hemodynamics were associated with decreases in left ventricular and increases in left atrial dimensions determined with echocardiography. Mitral valve excursion and the duration of valve opening remained constant over the entire range of A-V intervals. There was angiographic evidence of retrograde blood flow from the left atrium into the pulmonary venous system at an A-V interval of -50 and -100 ms, but no evidence of mitral regurgitation. Thus, correlative echocardiographic and hemodynamic studies can suggest multiple pathophysiologic mechanisms contributing to the decrements in cardiac function observed during tachyarrhythmias with intact A-V conduction as well as those occurring consequent to A-V nodal Wenckebach cycles.