Effects of posture, Valsalva maneuver and respiration on atrial flutter rate: an effect mediated through cardiac volume.

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  • Author(s): Waxman MB;Waxman MB; Yao L; Cameron DA; Kirsh JA
  • Source:
    Journal of the American College of Cardiology [J Am Coll Cardiol] 1991 Jun; Vol. 17 (7), pp. 1545-52.
  • Publication Type:
    Journal Article; Research Support, Non-U.S. Gov't
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Elsevier Biomedical Country of Publication: United States NLM ID: 8301365 Publication Model: Print Cited Medium: Print ISSN: 0735-1097 (Print) Linking ISSN: 07351097 NLM ISO Abbreviation: J Am Coll Cardiol Subsets: MEDLINE
    • Publication Information:
      Original Publication: [New York, N.Y.] : Elsevier Biomedical, [c1983-
    • Subject Terms:
      Atrial Flutter/*physiopathology ; Cardiac Volume/*physiology ; Posture/*physiology ; Respiration/*physiology ; Valsalva Maneuver/*physiology; Atropine ; Butylscopolammonium Bromide ; Cardiac Catheterization ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Propranolol ; Receptors, Adrenergic, beta/physiology ; Receptors, Muscarinic/physiology
    • Abstract:
      The effects of passive upright tilting from 0 degrees to +60 degrees (n = 27), Valsalva maneuver (n = 16) and respiration (n = 10) on the rate of atrial flutter were studied in 27 patients. After tilting to +60 degrees, the atrial flutter cycle length shortened in all patients from 247.5 +/- 7 to 236.7 +/- 6.9 ms (range of shortening 1 to 21 ms, p less than 0.001). The Valsalva maneuver (strain of 40 mm Hg) shortened the flutter cycle length during the strain (phase 2) from 242.2 +/- 4.6 to 230.5 +/- 5 ms (range of shortening 2 to 19 ms, p less than 0.001). In 10 patients whose respiration was monitored, the flutter cycle length consistently prolonged during inspiration and shortened during expiration. Combined beta-adrenergic and muscarinic receptor blockade in six patients did not significantly alter the flutter cycle length at rest or the effects of the various maneuvers on the changes in flutter cycle length. This study revealed that the atrial flutter cycle length can be shortened by passive upright tilting, the strain phase of the Valsalva maneuver and expiration. Changes in flutter cycle length were independent of autonomic tone, implying that by decreasing cardiac volume, these maneuvers affect characteristics of the atrial flutter circuit, thereby producing dynamic changes in the rate of atrial flutter.
    • Accession Number:
      0 (Receptors, Adrenergic, beta)
      0 (Receptors, Muscarinic)
      2Z3E1OF81V (Butylscopolammonium Bromide)
      7C0697DR9I (Atropine)
      9Y8NXQ24VQ (Propranolol)
    • Publication Date:
      Date Created: 19910601 Date Completed: 19910627 Latest Revision: 20190708
    • Publication Date:
      20231215
    • Accession Number:
      10.1016/0735-1097(91)90645-p
    • Accession Number:
      1851771