Reappraisal of inhibition and summation with a single conditioning stimulus in man

A noncapturing conditioning stimulus is known to exert inhibitory effect on a subsequent suprathreshold stimulus, while summation occurs rarely in man. The present study was conducted to revaluate whether conditioning stimulus at a relatively low intensity produced inhibition and summation in man. Thirteen patients with various arrhythmias, 47 +/- 19 years old, were studied. Basic ventricular driving stimuli (S1S1 = 600 msec), a conditioning stimulus (Sc), and extrastimulus (S2) were introduced from a catheter electrode. Sc at an intensity of twice the late diastolic threshold inhibited suprathreshold S2 from evoking a response in all 13 patients. The ScS2 interval producing inhibition was from 11 +/- 4 to 38 +/- 26 msec. When Sc preceded S2 by 5 msec, effective refractory period was shortened by 16 +/- 7 msec in 7 of 13 patients, a phenomenon of summation. The present study demonstrates that inhibition and summation are common phenomena with a single conditioning stimulus at relatively low intensities.