The Ventriculophasic Response: Relationship to Sinus Arrhythmia and the Duration of Interposed QRS Complexes

Authors


  • Disclosures: The authors have no financial or intellectual conflicts of interest relevant to this research. The research was not supported by external funding.

Address for correspondence: Craig A. McPherson, M.D., Cardiology Section, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610. Fax: 203-384-3443; E mail: pcmcph@bpthosp.org

Abstract

Background

The ventriculophasic response (VR) refers to shortening of sinus cycle length during heart block when a QRS complex is interposed between 2 P waves. Our purpose was to analyze its relationship to respiratory sinus arrhythmia (SA) and to compare VR in relation to paced versus intrinsic QRS complexes.

Methods

Patients with advanced heart block had their pacer devices temporarily programmed to ventricular inhibited mode at 30 ppm. In 35 subjects, we analyzed VR and SA before, during and after 3 cycles of deep breathing. In 16 other patients we compared VR in the presence of paced versus narrower intrinsic QRS complexes.

Results

The magnitude of P-P interval shortening surrounding QRS complexes during inspiration correlated with SA (r = 0.36, P = 0.03). The prevalence of VR increased from 37% at baseline to 77% of subjects during deep breathing (P = 0.02). The mean P–P interval shortening was greater surrounding intrinsic QRS complexes than paced QRS complexes (3.6 ± 3.6% vs. 1.4 ± 1.1%, P = 0.02). The prevalence of VR increased from 25% during paced rhythm to 56% when intrinsic complexes were present.

Conclusion

VR, like SA, increases with deep breathing and likely reflects intact parasympathetic nervous system function. Its increase in the presence of narrower beats suggests it may reflect ventricular synchrony.

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