Comparative effects of overdrive on sinus and subsidiary pacemaker function

Jordan, Jay L.; Yamaguchi, Iwao; Mandel, William J.; McCullen, Avile

doi:10.1016/s0002-8703(77)80256-1

Cited by 30 publications

(5 citation statements)

References 22 publications

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“…However, although the influence of the pacing cycle length was highly significant, its overall contribution to SNRT is rather small contributing less than 3 % (Table 3). This finding is again in agreement with our previous report (18) and those of others (8,17) who have also indicated that the pacing cycle length plays only a minor role in determining the extent of sinus node overdrive suppression Since the maximum pacing rate was in excess of 250 beats/minute, the question arises of whether sinus node entrance and/or exit block ever occurred. Thrc is no direct answer to this question because we did not assess conduction into or out of the sinus node with microelectrode techniques.…”

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

“…Since Gaskell's early observation (7), many reports (3,6,8,9,11,14,15,(17)(18)(19) have examined and discussed the nature of the post-pacing pause which is now commonly thought to be due to overdrive suppression (14,26). Because measurement of sinus node recovery time (SNRT) is one of the most common clinical and experimental electrophysiological tests of sinus node function (8,11,14,15,17,23), it is important to know which variables will influence SNRT and how they will do so. Numerous studies have shown that SNRT varies with the pacing rate (11,14,15,19,28), the duration of pacing (9,11,14), the stimulus strength (3,29), the spontaneous rate (6,15,20,25) and neurohumoral influences (2,9,11,14), but in each of these studies each variable was examined independently (6,9,11,14,28), thus precluding an overall assessment of the interrelationships between variables and between each variable and SNRT.…”

Section: Discussionmentioning

confidence: 99%

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The effects of negative chronotropic interventions on sinus node recovery time

1987

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The effects of multiple increases in sinus cycle length on sinus node recovery time (SNRT) were examined in 5 dogs. Pacing was performed from the left atrial appendage for 30 and 60 seconds using at least 4 different pacing cycle lengths selected between 230 and 620 msec. Each dog received propranolol (1 mg/kg, IV) prior to any measurements. The effects of increases in sinus cycle length on SNRT were first assessed during 2 levels (4 and 8 Hz) of continuous vagal stimulation. From a control cycle length of 439 +/- 28 msec (mean +/- SE), the vagal stimulations lengthened the sinus cycle lengths to 604 +/- 10 msec and 758 +/- 16 msec respectively. Sinus cycle length was then prolonged by combined muscarinic and beta-receptor blockade resulting in a sinus cycle length of 549 +/- 9 msec. Autonomic blockade plus verapamil (3-10 mg IV) resulted in sinus cycle lengths of 612 +/- 14 and 721 +/- 18 msec respectively, which were not significantly different from those obtained with vagal stimulation. Data relating SNRT to the sinus cycle length, pacing cycle length, duration of pacing and the negative chronotropic interventions used to achieve the changes in the sinus cycle length were analyzed via covariance analysis. The results demonstrate that the single most important determinant of SNRT is the sinus cycle length. Furthermore, equivalent increases in sinus cycle length whether obtained by vagal stimulation, autonomic blockade or intravenous verapamil results in SNRTs that are not significantly different. Therefore, in the sinus node, changes in the rate of pacemaker activity, regardless of how they are achieved, will largely determine the changes in SNRT.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The effects of negative chronotropic interventions on sinus node recovery time

1987

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“…In experimental studies,3-'0 as well as in humans,39,11,12 a direct relation between overdrive pacing rate and escape interval was observed; however, the correlation between these two variables was precisely defined by only Jordan et al 9 In this study, a biphasic increase in the escape interval was observed in humans, whereas in dogs, a linear relation between pacing rate and recovery time was found. Contrary to these observations, in the present study, incremental VOS was associated with an exponential increase in VRT, and on only three out of 42 occasions after an initial exponential increase, a sudden decrease in VRT was observed at high stimulation rates.…”

Section: Resultsmentioning

confidence: 50%

Subsidiary pacemaker function in complete heart block after His-bundle ablation.

et al. 1988

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To investigate the electrophysiological properties of ventricular impulse formation after His-bundle ablation in 11 patients, incremental ventricular overdrive stimulation studies were performed. The studies, which were spread over a follow-up period of up to 601 days, were carried out invasively with temporary leads as well as noninvasively with the implanted pacemakers and chest wall inhibition. The overdrive pacing rate was increased in steps of 10 beats/min, and the pacing duration was 2 minutes at each level. (Circulation 1988;78:893-898) S ince its introduction in humans,' 2 closed-chest ablation of the atrioventricular conduction system has become a routine therapeutic alternative for the treatment of supraventricular tachycardias unresponsive to medical treatment. The purpose of the procedure is to create complete heart block to prevent rapid ventricular response during supraventricular tachycardias. In the setting of complete heart block, overdrive suppression of subsidiary pacemakers is abolished and ventricular tissue assumes the function of impulse formation initiating the activation of the heart. However, because the rate of the newly established subsidiary rhythm and its adaptation during physical activity usually does not meet the demand, the majority of these patients require permanent ventricular pacing, and some will become completely pacing dependent.

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“…Dual AVN pathways were defined by more than 50 ms increase in the A2H2 interval with a 10 ms decrement in the A1A2 interval. Sinus node recovery time (SNRT) and corrected sinus node recovery time (CSNRT), and sino-atrial conduction time (SACT) was thought to be abnormal when SNRT >1,400 ms, 9 CSNRT >525 ms, 10 and SACT >250 ms. 11 One patient underwent programmed ventricular stimulation with up to double extrastimuli from the right ventricular apex and outflow tract under the control state and during isoproterenol infusion because of recurrent sustained ventricular tachycardia (VT).…”

Section: Methodsmentioning

confidence: 99%

Association of Sinus Node Dysfunction, Atrioventricular Node Conduction Abnormality and Ventricular Arrhythmia in Patients With Kawasaki Disease and Coronary Involvement

Sumitomo

Karasawa

Taniguchi

et al. 2008

Circ J

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Although there was no relationship between coronary stenosis or obstruction and the EPS parameters, the incidence of abnormal sinus node and atrioventricular node function is apparently higher in KD patients than in the normal population. These functional abnormalities may possibly be caused by myocarditis or an abnormal microcirculation in the sinus node and atrioventricular node artery. In some patients, myocardial ischemia may provoke malignant ventricular arrhythmia.

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Comparative effects of overdrive on sinus and subsidiary pacemaker function

Cited by 30 publications

References 22 publications

The effects of negative chronotropic interventions on sinus node recovery time

The effects of negative chronotropic interventions on sinus node recovery time

Subsidiary pacemaker function in complete heart block after His-bundle ablation.

Association of Sinus Node Dysfunction, Atrioventricular Node Conduction Abnormality and Ventricular Arrhythmia in Patients With Kawasaki Disease and Coronary Involvement

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