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Related Experiment Videos

Origin of the sinus impulse

R B Schuessler1, J P Boineau, B I Bromberg

  • 1Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.

Journal of Cardiovascular Electrophysiology
|March 1, 1996
PubMed
Summary
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The traditional view of a single sinus node pacemaker is challenged by evidence of dynamic, multicentric impulse origin in the atria. This review explores the evolution of our understanding of cardiac impulse initiation and regulation.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Anatomy

Background:

  • The established model posits a single, static sinus node as the origin of normal atrial impulse generation.
  • Conflicting early data indicated dynamic changes in the sinus node's pacemaker site with interventions affecting heart rate.
  • Atrial rhythms persisted even after sinus node removal, suggesting alternative impulse origins.

Purpose of the Study:

  • To review the historical development and evolution of the model for normal impulse origin in the atria.
  • To examine evidence supporting a dynamic and multicentric origin of cardiac impulses.
  • To understand the coordination and regulation of atrial pacemakers.

Main Methods:

  • Review of historical literature and conflicting experimental data.

Related Experiment Videos

  • Analysis of high-resolution mapping studies in human and canine subjects.
  • Examination of recent canine data on sinus node insulation and impulse propagation.

    • Main Results:

    • High-resolution mapping revealed dynamic, multicentric impulse initiation, with multiple foci contributing to a single beat.
    • Shifts in impulse origin sites correlated with heart rate changes and P wave variations on ECG.
    • Canine studies suggest the sinus node may have discrete exit sites and a dominant pacemaker that can shift within the node.
    • Extranodal pacemakers can influence or dominate impulse initiation, interacting with the autonomic nervous system.

    Conclusions:

    • The model of atrial impulse origin has evolved from a single static focus to a dynamic system with a shifting dominant pacemaker within the sinus node.
    • Multicentric impulse initiation and the influence of extranodal pacemakers, regulated by the autonomic nervous system, provide a more comprehensive understanding of heart rate control.