SUMMARYThe phenomenon of postpacing depression of cardiac pacemakers was utilized to evaluate the sinus-node function in 56 patients by analyzing the sinus-node recovery time (SRT), that is, the interval between the last paced P wave and the following sinus P wave. Corrected SRT (CSRT) is defined as the recovery interval in excess of the sinus cycle (SRT -sinus cycle length). The SRT was measured following sinusnode suppression by (1) isolated premature beats (PABs) and (2) atrial pacing (AP) at rates of 100 to 140/min for periods of 2 to 5 min at each level. Twentyeight patients had normal heart rates (group A), and 28 patients had sinus bradyeardia (SB; group B). Ten of the 28 patients with SB were restudied after receiving atropine (2 mg intravenously). The CSRT with PABs was similar in both group A and group B patients and remained essentially unchanged after atropine despite a decrease in sinus cycle length. The phenomenon of interpolated PABs was demonstrated in seven of the 56 patients. In 27 of the 28 patients with normal heart rates (group A), the CSRT with AP ranged from 110 to 525 msec and was essentially independent of the rate and duration of AP. In the remaining one patient of group A, despite a normal heart rate, the CSRT was prolonged (1810 msec) and directly dependent on the rate and duration of AP. In 12 of the 28 patients with SB, the CSRT was comparable to that in group A (<525 msec). In the remaining 16 patients with SB (group B), the CSRT ranged from 560 to 3740 msec and was usually directly proportional to the rate and duration of AP. After atropine in most of the patients with a prolonged CSRT, the CSRT remained abnormal whereas in others junctional escape beats appeared first, followed eventually by normal sinus rhythm. In a single patient with SB and an abnormal CSRT, restudy 7,i months later again showed a prolonged CSRT indicating the reproducibility of the measurement. The CSRT with AP provides a potentially useful clinical means of assessing the sinus-node function and thereby aids in the diagnosis of the "sick sinus syndrome." It is stressed that AP was found to be more reliable than PABs in eliciting an abnormal response. Furthermore, a normal sinus (atrial) rate does not necessarily provide assurance of a normal sinusnode response to AP, that is, normal sinus-node function.

Methods were devised for the selective alteration of parasympathetic control over the sinoatrial (SA) or the atrioventricular (AV) node in anesthetized, thoracotomized mongrel dogs. Two epicardial sites were located at which parasympathetic nerve fibers enroute to the SA or the AV node could be stimulated or blocked. Selective nerve stimulation was accomplished with brief pulses (0.05 msec), and blockade was accomplished with topically applied lidocaine. At the intercaval site, only the SA node was affected. At the site near die coronary sinus ostium, only the AV node was affected in terms of parasympathetic control, but sometimes there were modest sympathetic effects on the SA node. The effects of stimulation at these sites, except for the SA speeding produced by stimulation at the site near the coronary sinus, were blocked by atropine. The effects were also blocked by ganglionic blockade. Probably, preganglionic parasympathetic fibers to the nodes are concentrated at these sites.

SUMMARYHis bundle electrograms were recorded and A-V junction pacing was achieved in 30 patients by a pervenous electrode catheter technic. His