Tachycardia Recognition and Diagnosis from Changes in Right Atrial Pressure Waveform—A Feasibility Study

Abstract

Implantable defibrillators either monitor heart rate or use a probability density function to detect ventricular fibrillation/tachycardia. As a result, they are unable to discriminate sinus tachycardia and atrial arrhythmias from malignant ventricular rhythms. We have assessed high fidelity fiber-optic pressure recordings in the right atrium during cardiac arrhythmias in 23 patients (mean age 44 years, 11 females) undergoing electrophysiological study. The unfiltered pressure signal was amplified and recorded on paper. During sinus rhythm, a constant amplitude deflection occurred during atrial systole (a wave). A characteristic waveform pattern was observed during each of the studied tachyarrhythmias, which included atrial flutter and fibrillation, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, and ventricular tachycardia with and without ventriculoatrial conduction. The waveform pattern allowed clear visual discrimination of the underlying arrhythmia. Mean atrial pressure was increased during all arrhythmias and did not allow discrimination of the nature of the tachycardia. High fidelity pressure recordings produced characteristic appearances for pattern recognition of each arrhythmia studied. They allowed determination of the temporal relation between electrical and mechanical cardiac events and may have potential in the detection and recognition of cardiac arrhythmias.

Influence of Ventriculoatrial Timing on Hemodynamics and Symptoms During Supraventricular Tachycardia

“…While Gùrsoy et al 3 . observed lower RAP and less flow reversal in the vena cava during atrial systole (assessed by angiography) during native AVRT than during native AVNRT, other studies failed to find a significant difference, in terms of right 13 and left atrial pressures (PCWP) 14 . The location of the bypass tract may affect the hemodynamics during AVRT.…”

Arrhythmias in adults with congenital heart disease and heart failure

“…Right atrial pressure generally increases in the context of a rapid tachyarrhythmia regardless of its underlying nature. 8 In patients with a patent foramen ovale or an ASD with a predominant left-to-right shunt at rest, the tachycardia-induced increase in right atrial pressure can result in shunt reversal with hypoxemia and symptoms of HF. The classic example is the patient with Ebstein anomaly and exertional or tachycardia-induced oxygen desaturation.…”

Current approaches and future developments in automatic tachycardia detection and diagnosis.

“…High fidelity pressure recordings clearly demonstrate the relation between atrial and ventricular contraction and characteristic patterns have been demonstrated associated with specific atrial and ventricular arrhythmias.65 Mean right atrial pressure showed an increase during all types of arrhythmia, regardless of haemodynamic stability, with a considerable degree of overlap between atrial and ventricular arrhythmias, though there was a preponderance of well tolerated arrhythmias in the study. 66 Development of a pattern-recognition algorithm and a reliable high fidelity chronic pressure sensing catheter may allow atrial pressure waveforms to become a realistic method for tachycardia diagnosis.…”