Isorhythmic Dissociation--a "physiological" arrhythmia

The behavior of the sino-atrial mechanism in isorhythmic dissociation (IRD) was studied in 21 patients, nine with spontaneous IRD and 12 with artificially pacemaker-induced IRD following electrode placement for heart block. Successive P-P, R-R and P-R intervals and blood pressure (BP) fluctuations were determined and graphically interrelated at control and during IRD. Several features were observed: a. IRD was present only when the independent ventricular rate was close to the atrial; b. P rate oscillations closely followed the P-R interval-dependent BP fluctuations (mean difference 30 mmHg) during IRD. In cardiogenic shock and in severe hypertension IRD could not be achieved easily; c. While during complete dissociation or during 1:1 A-V conduction the sinus rate was remarkably constant (2-4 beats/min variations), it showed marked oscillations (differences of 6-19, mean 13, beats/min) during IRD. All the data and calculations support the theory that in most instances of IRD, the arrhythmia is sustained by the normal physiologically active baroreceptor reflex arc.