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Related Experiment Videos

Response of normal and abnormal sinus node to right ventricular stimulation

J J Blanc, E Gestin, D Guillerm

    The American Journal of Cardiology
    |September 1, 1981
    PubMed
    Summary

    Right ventricular pacing has a smaller effect on atrial rate in patients with sick sinus syndrome compared to those with normal sinus function. This suggests a mechanical effect on the sinus node, not autonomic influence.

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    Area of Science:

    • Cardiology
    • Electrophysiology
    • Physiology

    Background:

    • Complete ventriculoatrial block necessitates understanding pacing effects on atrial rate.
    • Sick sinus syndrome (SSS) may alter the heart's response to pacing.

    Purpose of the Study:

    • To investigate the relationship between right ventricular pacing rate and atrial rate in patients with complete ventriculoatrial block.
    • To compare this relationship in patients with SSS versus those with normal sinus function.
    • To assess the role of autonomic blockade in modulating this response.

    Main Methods:

    • Right ventricular pacing at increasing rates in 25 patients with complete ventriculoatrial block.
    • Recording of right intraatrial electrograms and ECG leads.
    • Comparison of atrial rate response before and after autonomic blockade (propranolol and atropine).

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    Main Results:

    • Patients with SSS (Group I) showed a significantly smaller increment in atrial rate (8 ± 6 bpm) compared to normal sinus function (Group II, 25 ± 10 bpm) during right ventricular pacing (p < 0.001).
    • Maximal atrial rates during pacing were lower in Group I (<74 bpm) than in Group II (>80 bpm).
    • Autonomic blockade did not significantly alter these findings.

    Conclusions:

    • Right ventricular pacing elicits a diminished atrial rate response in patients with SSS.
    • A mechanical effect on the sinus node, rather than autonomic modulation, likely explains this phenomenon.
    • Findings highlight distinct electrophysiological responses in SSS patients.