Circulation, Vol 85, 1064-1071, Copyright © 1992 by American Heart Association
JW Leitch, GJ Klein, R Yee, RA Leather and YH Kim
BACKGROUND. Syncope in patients with supraventricular tachycardia has been
suggested to be an ominous finding, predictive of rapid rates during
tachycardia. METHODS AND RESULTS. To explore the mechanism of syncope
during supraventricular tachycardia, tachycardia was induced in the supine
position and after passive head-up tilting to 60 degrees in 13 patients
with atrioventricular (AV) node reentry, eight patients with AV reentry,
and one patient with atrial tachycardia. Tilt testing was also performed in
sinus rhythm for 30 minutes (the last 15 minutes with isoproterenol
infusion). Mean +/- SEM age was 38 +/- 3 years, and 11 patients had a
history of syncope (median number of syncopal episodes, three; range, one
to 30). The cycle length of tachycardia when upright was shorter than when
supine (297 +/- 9 compared with 357 +/- 10 msec, p less than 0.001), and
mean blood pressure fell to a greater extent after the onset of tachycardia
(fall in mean blood pressure, 53 +/- 6 compared with 24 +/- 3 mm Hg, p less
than 0.001). Mean blood pressure correlated significantly with tachycardia
cycle length when supine (r = 0.58, p = 0.005) but not when tilted upright
(r = 0.18, p = 0.45). Syncope occurred in seven patients during upright
tachycardia. These seven patients had a greater fall in mean blood pressure
with upright tachycardia than the 15 patients without syncope (fall in mean
blood pressure, 70 +/- 4 compared with 45 +/- 5 mm Hg, p = 0.01), but there
was no difference in the tachycardia cycle length (311 +/- 10 compared with
290 +/- 11 msec, p = 0.29). Six of the seven patients with
tachycardia-induced syncope also had syncope with tilt testing in sinus
rhythm compared with four of the 15 patients without tachycardia-induced
syncope (p = 0.02). CONCLUSIONS. These data support the view that syncope
during supraventricular tachycardia is related to vasomotor factors and
does not predict a more rapid tachycardia rate.
ARTICLES
Syncope associated with supraventricular tachycardia. An expression of tachycardia rate or vasomotor response?
Department of Medicine, University of Western Ontario, London, Canada.
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