Functional characteristics of sinoatrial and subsidiary pacemaker activity in the canine right atrium

A canine in vitro right atrial preparation was developed to study the functional characteristics of subsidiary atrial pacemaker (SAP) activity and to compare them with those of sinoatrial node (SAN) activity. Extracellular bipolar electrodes were used to estimate the site of earliest activation and monitor spontaneous rate. Ligation of the SAN artery at the midportion of the sulcus terminalis suppressed SAN activity and usually (73.5%) elicited SAP activity in a well-defined region of the inferior atrium. SAP activity in this region required a "threshold" concentration of norepinephrine (10(-8) M) in the Tyrode's perfusate. In response to all concentrations of norepinephrine tested, SAN activity attained a greater maximum spontaneous rate than SAP activity. Cholinergic stimulation with acetylcholine or eserine elicited a greater negative chronotropic response from SAP than SAN activity. Overdrive pacing suppressed SAP activity to a significantly greater extent than SAN activity. We conclude that this in vitro preparation can be useful for studying the pharmacology and electrophysiology of subsidiary atrial pacemakers that emerge after suppression of SAN activity. In contrast to SAN activity, SAP activity requires norepinephrine and is more sensitive than SAN activity to acetylcholine and overdrive pacing. Consequently, after loss of SAN function, autonomic modulation of SAP activity may result in atrial dysrhythmias and prolonged periods of overdrive suppression.