Background A reduction of complexity of heart-beat interval variability (BIV) that is associated with an increased morbidity and mortality in cardiovascular disease states is thought to derive from the balance of sympathetic and parasympathetic neural impulses to the heart. But rhythmic clock-like behavior intrinsic to pacemaker cells within the sinoatrial node (SAN) drives their beating, even in the absence of autonomic neural input. Objective To test how this rhythmic clock-like behavior intrinsic to pacemaker cells interacts with autonomic impulses to the heart-beat interval variability in vivo. Methods We analyzed BIV in the time and frequency domains and by fractal and entropy analyses: i) in vivo, when the brain input to the SAN is intact; ii) during autonomic denervation in vivo; iii) in isolated SAN tissue (i.e., in which the autonomic-neural input is completely absent); iv) in single pacemaker cells isolated from the SAN; and v) following autonomic receptor stimulation of these cells. Results Spontaneous-beating intervals of pacemaker cells residing within the isolated SAN tissue exhibit fractal-like behavior and have lower approximate entropy than in the intact heart. Isolation of pacemaker cells from SAN tissue, however, leads to a loss in the beating-interval order and fractal-like behavior. β adrenergic receptor stimulation of isolated pacemaker cells increases intrinsic clock synchronization, decreases their action potential period and increases system complexity. Conclusions Both the average-beating interval in vivo and beating interval complexity are conferred by the combined effects of clock periodicity intrinsic to pacemaker cells and their response to autonomic-neural input.

SummaryWe aimed to determine how age‐associated changes in mechanisms extrinsic and intrinsic to pacemaker cells relate to basal beating interval variability (BIV) reduction in vivo. Beating intervals (BIs) were measured in aged (23–25 months) and adult (3–4 months) C57BL/6 male mice (i) via ECG in vivo during light anesthesia in the basal state, or in the presence of 0.5 mg mL−1 atropine + 1 mg mL−1 propranolol (in vivo intrinsic conditions), and (ii) via a surface electrogram, in intact isolated pacemaker tissue. BIV was quantified in both time and frequency domains using linear and nonlinear indices. Although the average basal BI did not significantly change with age under intrinsic conditions in vivo and in the intact isolated pacemaker tissue, the average BI was prolonged in advanced age. In vivo basal BIV indices were found to be reduced with age, but this reduction diminished in the intrinsic state. However, in pacemaker tissue BIV indices increased in advanced age vs. adults. In the isolated pacemaker tissue, the sensitivity of the average BI and BIV in response to autonomic receptor stimulation or activation of mechanisms intrinsic to pacemaker cells by broad‐spectrum phosphodiesterase inhibition declined in advanced age. Thus, changes in mechanisms intrinsic to pacemaker cells increase the average BIs and BIV in the mice of advanced age. Autonomic neural input to pacemaker tissue compensates for failure of molecular intrinsic mechanisms to preserve average BI. But this compensation reduces the BIV due to both the imbalance of autonomic neural input to the pacemaker cells and altered pacemaker cell responses to neural input.