Bradycardia-dependent activation delay of the atrial tissue in a patient with sick sinus syndrome

Bradycardia-dependent block or activation delay of the atrial tissue has not been documented in the literature. A patient with sick sinus syndrome in whom bradycardia-dependent, as well as tachycardia-dependent, activation delay in the atria was elucidated is reported on. The phenomenon of bradycardia-dependent activation delay was reproducibly demonstrated, both during atrial extrastimulation and incremental atrial pacing from the high right atrium, in the setting of an abnormally prolonged activation interval from the distal stimulating electrodes to the proximal recording electrodes of a quadripolar catheter, which was localized in the high right atrial region. Supernormal conduction seemed to be an unlikely explanation for the observed phenomenon.