Heat rate responses in patients with sinus node disease compared to controls: physiological implications and diagnostic possibilities

The autonomic regulation of heart rate was examined in 30 patients with symptoms of sinus node disease (SND) and 18 control subjects. Heart rate, expressed as sinus cycle length, was determined after injection of isoprenaline (0.1 microgram/kg), propranolol (0.1 mg/kg), and atropine (0.02 mg/kg); heart rate was also determined at maximal exercise and during carotid sinus stimulation. In addition, heart rate responses, expressed as the absolute change in sinus cycle length, were calculated. Mean heart rates after the applied maneuvers were all significantly different in the patient group, but so was the mean spontaneous heart rate. None of the induced changes differed significantly between the groups. Thus, although all these patients had impaired sinus node automaticity no uniform decrease in responsiveness to adrenergic or cholinergic stimulation or to inhibition of autonomic influences could be detected. The response patterns were heterogeneous, indicating diversity of the underlying mechanisms. No single heart rate reaction provided a satisfying diagnostic capacity for SND. However, the combined sensitivity of the three tests--isoprenaline stimulation, carotid sinus pressure, and autonomic inhibition--was 97% with a specificity of 50%. Clinically, normal findings in all these three tests, i.e., with resulting heart rates greater than 100, 55, and 70 beats/min, respectively, strongly suggest absence of SND.