INEFFECTIVE DIASTOLIC FILLING IN TACHYCARDIA-INDUCED CARDIOMYOPATHY WITH TOTAL PULSUS ALTERNANS

We report a case of total pulse alternans in a patient with paroxysmal ectopic atrial tachycardia and echocardiographic findings obtained be fore and after radiofrequency catheter ablation (RFCA) that terminated the arrhythmia. The patient was a 27-year-old man with history of par oxysmal palpitations with worsening episodic dizziness, chest tightnes s, and dyspnea. Electrocardiography (EGG) showed atrial tachycardia at 160 to 170 beats/min while the simultaneous pulse was in the 80s beat s/min. Echocardiogram showed that aortic and mitral valves opened with alternating excursions and outflow velocities. Furthermore, despite s imilar ventricular wall thickening during systole of consecutive cardi ac cycles, there was alternating mitral valve opening during diastole of tile same cycles, providing direct evidence that ineffective diasto lic filling and mitral valve opening may play a role in the pathogenes is of pulse alternans. Repeat ECG and echocardiography after the succe ssful RFCA showed normal sinus rhythm and normal opening excursion and the velocity across the aortic and mitral valves.