Sinus Node Inhibition During Ventricular Stimulation

Abello, Maurício; Peinado, Rafaél; Merino, José Luís; Peinado, Ángel Aroca

doi:10.1046/j.1540-8167.2002.01181.x

Cited by 4 publications

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“…Our finding confirms that this possibility also could occur in patients with completely normal sinus node function and AV conduction and supports a neurocardiogenic mechanism, 3 as pointed out by Dr. Batchvarov in his article 2 …”

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confidence: 89%

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Abello

Peinado

Merino

et al. 2003

Cardiovasc electrophysiol

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supporting

confidence: 89%

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Abello

Peinado

Merino

et al. 2003

Cardiovasc electrophysiol

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“…Sinus node inhibition during ventricular pacing in the absence of VA conduction is rarely observed during electrophysiologic studies 1,2 . Hypothetically, it is caused by an increase in vagal activity secondary to stimulation of ventricular mechanoreceptors 3 .…”

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confidence: 99%

Cardioinhibition Secondary to Ventricular Pacing

Salinas

Pérez‐Castellano

Isa

et al. 2006

Cardiovasc electrophysiol

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A 19-year-old woman with exercise-induced palpitations and recurrent syncopal episodes was referred for electrophysiologic study. Holter monitoring showed sinus arrhythmia, first-degree atrioventricular (AV) block (PR interval: 280 msec), and occasional type I, 2 • degree AV block. The Jorge Salinas received a grant from the Fundación Carolina, Spain, for participating in a training program in cardiac electrophysiology in the Cardiovascular Institute, Figure 1. Upper panel: Sinus node inhibition during ventricular pacing in the absence of VA conduction. At the end of pacing, there is suprahisian AV block of one atrial beat (asterisk), which can be better appreciated at the bottom panel. This observation was reproducible and indicates that cardioinhibitory effects of ventricular pacing were also elicited on the AV node. A = atrial beat; P = ventricular paced beat.electrophysiologic study showed normal corrected sinus node recovery time (350 msec), normal sinoatrial conduction time (105 msec), and dual antegrade nodal pathways. The AV node Wenckebach block cycle length was 380 msec. There was neither inducible tachycardia nor VA conduction. Surprisingly, a sustained sinus node inhibition was observed during ventricular pacing at 600 msec cycle length. Suprahisian AV block was also observed once ventricular pacing was stopped (Fig. 1). What is the mechanism responsible for this phenomenon? DiscussionSinus node inhibition during ventricular pacing in the absence of VA conduction is rarely observed during electrophysiologic studies. 1,2 Hypothetically, it is caused by an increase in vagal activity secondary to stimulation of ventricular mechanoreceptors. 3 To verify this hypothesis, we assessed

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“…It is unclear whether this phenomenon is indeed so rare, keeping in mind that fixed‐rate ventricular pacing at several cycle lengths with direct recording from at least one atrial site is a standard step of practically every EP study or is, in the words of Lord Byron, “less often sought than found.” 4 Sinus inhibition seems related to the neurocardiogenic syndromes, as hinted by Abello et al, 1 to the recently described heart rate turbulence, 5 and to the so‐called “ventriculo‐phasic arrhythmias” (see list of references in Schmidt et al 5 ). It seems logical to speculate that, in some cases, ventricular pacing could trigger vasodilation instead of (or in addition) to sinus inhibition and cause symptoms (e.g., “pacemaker syndrome”).…”

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confidence: 95%

“…I read with interest the report by Abello et al 1 describing sinus node inhibition during ventricular stimulation. It probably is worth recalling some previous reports of this rare syndrome.…”

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confidence: 99%

To the Editor:

Batchvarov¹

2003

Cardiovasc electrophysiol

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Sinus Node Inhibition During Ventricular Stimulation

Cited by 4 publications

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Cardioinhibition Secondary to Ventricular Pacing

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