Atrioventricular conduction in mammalian species: Hemodynamic and electrical scaling

OBJECTIVES The purpose of this study was to investigate scaling of the duration of late diastolic left ventricular (LV) filling in relation to AV conduction time (delay) (PR interval on the ECG) in mammals. BACKGROUND From mouse to whale, AV delay increases 10-fold, whereas body mass increases one million-fold. The apparent "mismatch" results from scaling of AV delay versus body and heart mass. METHODS We measured (1) mitral orifice diameter in 138 postmortem hearts of 48 mammalian species weighing between 17 g and 250 kg and (2) transmitral diastolic flow using magnetic resonance imaging (MRI) recordings of 10 healthy human individuals. (3) We visually inspected early and late diastolic LV filling. (4) We developed two physical models to explain scaling of late diastolic LV filling time. RESULTS (1) Diameter of the mitral orifice proportionally relates to heart length (third root of heart mass). (2) Atrial contraction starts at a fixed instant (± 80%) of the (normalized) cardiac cycle and contributes 31% ± 5% to LV filling. (3) MRI shows that during diastole, the left atrium (LA) and LV form a single space. (4) The physical models relate the duration of late diastolic LV filling directly to heart length, the third root of heart mass. CONCLUSIONS (1) Late diastolic (LV) filling time scales with heart length (third root of heart mass). (2) No "mismateh" exists between AV delay and heart size. (3) Knowledge of the actual starting time of atrial contraction may contribute to better treatment of patients with heart failure. (4) The findings suggest that in evolution of mammalian species, hemodynamics commands electrical behavior of the heart