Heart 1998;79:490-492 ( May )
Neck pounding during sinus rhythm: a new clinical manifestation of dual atrioventricular nodal pathways
a Cardiovascular Centre, OLV Hospital, Aalst, Belgium, b Arrhythmia Unit, Hospital Clinic, University of Barcelona,
Barcelona, Spain
Correspondence to: Dr Peter Geelen, Cardiovascular Centre, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium. email: fellows.cardio{at}olvz-aalst.be
Accepted for publication 12 January 1998
Objective
To determine the clinical and
electrophysiological characteristics of patients with paroxysmal
palpitations and neck pounding during sinus rhythm.
MethodsClinical, electrocardiographic, and
electrophysiological characteristics of six patients with paroxysmal
palpitations and neck pounding during sinus rhythm were studied in
basal conditions and when symptomatic. Response to treatment was observed.
ResultsBaseline ECGs were normal (four patients)
or had first degree atrioventricular block with intermittent PR
shortening. During symptoms, narrow QRS rhythms were seen without
visible P waves (three patients) or with P waves partially hidden in
the QRS complex (three patients). Dual atrioventricular nodal pathways
were found in all five patients who had electrophysiological studies.
In these patients the slow pathway conduction time was long enough (mean (SD), 425 (121) ms) for ventricular activation after slow pathway conduction during sinus rhythm to coincide with the next atrial
depolarisation, causing neck pounding during exercise (four patients)
or at rest (two patients). Tachycardia was not induced in any patient.
Medical treatment aggravated symptoms in three patients. A pacemaker
was successfully used in two.
ConclusionsNeck pounding during sinus
rhythm is a clinical manifestation of dual atrioventricular nodal
pathways. Medical treatment may aggravate symptoms but a pacemaker may
offer definitive relief.
© 1998 by Heart
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
- Full Text
- Full Text (PDF)
- Submit a response
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
Services
- Email this link to a friend
- Similar articles in this journal
- Similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Topic Collections
-
Drugs: cardiovascular system
-
Bradyarrhythmias and heart block
-
Tachyarrhythmias
- Pacing and electrophysiology
Bookmark with
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
