Systolic Pulmonary and Hepatic Vein Flow Reversal Due to Pacemaker‐Induced Retrograde Ventriculoatrial Conduction

Abstract

Systolic pulmonary and hepatic vein flow reversals can typically be seen with severe atrioventricular (AV) valve regurgitation and during atrial fibrillation (AF). We report the case of a 67-year-old woman who presented with recent-onset exertional dyspnea. Her pacemaker was near end-of-life and reverted to a VVI mode from the preset DDDR mode. Electrocardiography demonstrated retrograde 1:1 ventriculoatrial (VA) conduction and spectral Doppler analysis revealed prominent systolic pulmonary and hepatic vein flow reversals. Symptoms, electrocardiogram (ECG) findings, and the spectral Doppler abnormalities resolved completely following a generator replacement and resumption of DDDR pacing.

Traumatic tricuspid valve injury following pacemaker lead extraction: A case report

“…SFR can also be appreciated on CDI and on CMM. Whilst SFR is a very specific sign of severe TR, other conditions may result in SFR especially when there is atrial contraction against a closed TV as in the case of paced rhythms, atrioventricular dissociation and atrial arrythmias 18,19 . In this patient, the rhythm was paced and there was underlying AF.…”

Spectral Doppler of the Hepatic Veins in Rate, Rhythm, and Conduction Disorders

“…9). 4,13,14 When atrial contraction occurs early in diastole, the A-wave becomes superimposed on the D-wave resulting in reduction in D-wave velocity and no clear A-wave.…”

“…When atrial contraction occurs during ventricular systole and against a closed TV, the rise in RA pressure results in large systolic “cannon wave” reversals (Fig. ) . When atrial contraction occurs early in diastole, the A‐wave becomes superimposed on the D‐wave resulting in reduction in D‐wave velocity and no clear A‐wave.…”

Unusual Cause of Hepatic Vein Systolic Flow Reversal

“…1) Hepatic or pulmonary vein systolic flow reversal can also occur in conditions causing atrioventricular dissociation such as complete heart block and ventricular tachycardia (VT); however, flow reversal will only occur during the beats when atrial and ventricular contraction is happening simultaneously. Theoretically, findings seen in Figure 1 can also occur due to pacemaker induced retrograde 1:1 ventriculoarterial (VA) conduction 2) or slow VT causing 1:1 retrograde VA conduction.…”