Evaluation of Sino-atrial Node Function in Man by Overdrive Suppression

TLDR

The study aims to use the pause after atrial pacing cessation to detect abnormalities of sino‑atrial node function. SAN function was assessed in 46 patients by pacing the right atrium for 15–180 s at 90–150 bpm. Rapid cessation of pacing caused SAN suppression, producing pauses that lengthened with pacing rate but shortened at 150 bpm; atropine reduced but did not abolish suppression, subthreshold pacing had no effect, and patients with sick sinus syndrome exhibited markedly longer pauses.

Abstract

Sino-atrial node (SAN) function was evaluated in 46 patients, three of whom had the sick sinus syndrome. Patients were paced from the right atrium for 15 to 180 sec at rates of 90, 110, 130, and 150 beats/min. The rapid cessation of pacing was associated with suppression of the SAN at all paced rates and at all durations of pacing. The observed pause was terminated by a sinus beat in all instances. The duration of pacing had little influence on the duration of the observed pause. The pause increased as the pacing rate was increased until, at a rate of 150 beats/min, a marked decrease in the pause was noted. Atropine (1.5-3.0 mg iv) diminished but did not eliminate the SAN suppression. Subthreshold pacing did not suppress SAN function. Three patients with sick sinus syndrome had a greater degree of SAN suppression than normal patients (4732 ± 415 msec [SSS] M ± sem ; 1041 ± 56 msec for normal patients). The determination of the duration of the pause following cessation of atrial pacing provides a technique for recognition of abnormalities of SAN function.