RT Journal Article
SR Electronic
T1 Neck pounding during sinus rhythm: a new clinical manifestation of dual atrioventricular nodal pathways
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 490
OP 492
DO 10.1136/hrt.79.5.490
VO 79
IS 5
A1 P Geelen
A1 J Primo
A1 J Brugada
A1 E Andries
A1 P Brugada
YR 1998
UL http://heart.bmj.com/content/79/5/490.abstract
AB Objective To determine the clinical and electrophysiological characteristics of patients with paroxysmal palpitations and neck pounding during sinus rhythm.Methods Clinical, 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.Results Baseline 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.Conclusions Neck 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.