Significance of the atrial contribution to ventricular filling

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      The contributions of atrial systole to ventricular filling are emphasized by analyses of pressure curve data in (1) patients with complete heart block studied by right and left heart catheterization, (2) patients with sinus rhythm and atrial fibrillation and (3) sinus rhythm and ventricular premature beats. The level of systolic and diastolic right and left heart pressures varies with the temporal relation between the P and QRS complexes in patients with complete heart block. Peak pressures are recorded when there is a normal temporal relation between the P and QRS complexes. The rate of rise of the systemic arterial pressure curve is also at a maximum when the normal P-QRS relation is maintained. Comparison of left ventricular and systemic arterial pressures during sinus rhythm and ventricular premature beats demonstrates higher systolic peak pressures during sinus rhythm with normal atrioventricular conduction; of equal importance is the observation that left ventricular end-diastolic pressures are higher during sinus rhythm than during a series of ventricular premature beats.
      One subject was studied during both atrial fibrillation and normal sinus rhythm in the course of left heart catheterization. Left ventricular. systolic and end-diastolic pressures were higher during normal sinus rhythm than during atrial fibrillation. The development of mitral regurgitation during ectopic ventricular beats is also illustrated. These data demonstrate the physiologic importance of maintaining the normal temporal sequence of atrioventricular activity.
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        • Samet P.
        • Jacobs W.
        • Bernstein W.H.
        • Shane R.
        Hemodynamic sequelae of idioventricular pacemaking in complete heart block.
        Am. J. Cardiol. 1963; 11: 594
        • Braunwald E.
        • Frahm C.J.
        Studies on Starling's law of the heart. IV. Observations on the hemodynamic function of the left atrium.
        Circulation. 1961; 24: 633
        • Wilson W.S.
        • Judge R.D.
        • Siegel J.H.
        A simple diagnostic sign in ventricular tachycardia.
        New England J. Med. 1964; 270: 466
        • Hecht H.H.
        • Osher W.J.
        • Samuels A.J.
        Cardiovascular adjustments in subjects with organic heart disease before and after conversion of atrial fibrillation to normal sinus rhythm.
        J. Clin. Invest. 1951; 30: 647
        • Kory R.C.
        • Meneely G.R.
        Cardiac output in auricular fibrillation with observations on the effects of conversion to normal sinus rhythm.
        J. Clin. Invest. 1951; 30: 653
        • Mitchell J.H.
        • Gilmore J.P.
        • Sarnoff S.J.
        The transport function of the atrium. Factors influencing the relation between mean left atrial pressure and left ventricular end-diastolic pressure.
        Am. J. Cardiol. 1962; 9: 237
        • Linden R.J.
        • Mitchell J.H.
        Relationship between left ventricular diastolic pressure and myocardial segment length and observations on the contribution of atrial systole.
        Circulation Res. 1960; 8: 1092
        • Gesell R.A.
        Cardiodynamics in heart block as affected by auricular systole, auricular fibrillation and stimulation of the vagus nerve.
        Am. J. Physiol. 1916; 40: 267
        • Wiggers C.J.
        • Katz L.N.
        Contour of ventricular volume curves under different conditions.
        Am. J. Physiol. 1921–1922; 58: 439
        • Samet P.
        • Bernstein W.H.
        • Medow A.
        • Nathan D.A.
        Effect of alterations in ventricular rate upon cardiac output in complete heart block.
        Am. J. Cardiol. 1964; 14: 477
        • Gleason W.L.
        • Braunwald E.
        Studies on the first derivative of the ventricular pressure pulse in man.
        J. Clin. Invest. 1962; 41: 80
        • Gilmore J.P.
        • Sarnoff S.J.
        • Mitchell J.H.
        • Linden R.J.
        Synchronicity of ventricular contraction: Observations comparing haemodynamic effects of atrial and ventricular pacing.
        Brit. Heart J. 1963; 25: 299
        • Skinner N.S.
        • Mitchell J.H.
        • Wallace A.G.
        • Sarnoff S.J.
        Hemodynamic effects of altering the timing of atrial systole.
        Am. J. Physiol. 1963; 205: 499
        • Brockman S.K.
        Dynamic function of atrial contraction in regulation of cardiac performance.
        Am. J. Physiol. 1963; 204: 597
        • Sarnoff S.J.
        • Gilmore J.P.
        • Mitchell J.H.
        Influence of atrial contraction and relaxation on closure of the mitral valve.
        Circulation Res. 1962; 11: 27
        • Grant C.
        • Greene D.G.
        • Bunnell I.L.
        The valve closing function of the right atrium.
        Am. J. Med. 1963; 34: 325
        • Jochim K.
        The contribution of the auricles to ventricular filling in complete heart block.
        Am. J. Physiol. 1938; 122: 639
        • Mitchell J.H.
        • Gupta D.N.
        • Payne R.M.
        Influence of atrial systole on effective ventricular stroke volume.
        in: Fed. Proc.23. 1964: 464
        • Sellers F.J.
        • Donald D.E.
        • Wood E.H.
        Atrial contribution to stroke volume in dogs with chronic cardiac denervation.
        Physiologist. 1962; 5: 211
      1. Samet, P. and Bernstein, W. H. Unpublished data.

        • Skinner N.S.
        • Mitchell J.H.
        • Wallace A.G.
        • Sarnoff S.J.
        Hemodynamic consequences of atrial fibrillation at constant ventricular rates.
        Am. J. Med. 1964; 36: 342
        • Nathan D.A.
        • Center S.
        • Wu C.
        An implantable synchronous pacemaker for the long term correction of complete heart block.
        Am. J. Cardiol. 1963; 77: 362