Elsevier

American Heart Journal

Volume 122, Issue 6, December 1991, Pages 1633-1643
American Heart Journal

Postextrasystolic sinoatrial exit block in human sick sinus syndrome: Demonstration by direct recording of sinus node electrograms

https://doi.org/10.1016/0002-8703(91)90281-LGet rights and content

Abstract

Ten patients with sick sinus syndrome having repetitive sinus node electrograms during long postpacing pauses were studied during programmed atrial stimulation. Sinus node activity was recorded using a percutaneous catheter electrode. A sinus node electrogram was recorded before the return atrial beat in seven patients; it was similar to the sinus node electrogram observed during postpacing pauses and is clearly identified because sinoatrial conduction time was markedly prolonged following the atrial extra beat. Complete sinoatrial exit block occurred in four patients. (1) Sinus node electrograms were thus validated both during postpacing pauses and during programmed atrial stimulation in most patients with sick sinus syndrome. (2) Sinoatrial conduction time was markedly prolonged after one extrasystole, accounting for supracompensatory atrial return cycles. (3) If it were cumulative following multiple extrasystoles, this effect could constitute the electrophysiologic link between an abnormal response during programmed atrial stimulation and the complete sinoatrial block recorded during the pauses that follow rapid atrial pacing.

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    The authors express their gratitude to Professor H. Warembourg, MD, and thank M. Blin, M. P. Théry, and I. Morenval for their expert secretarial assistance. We also thank Dr. E. Kraus for assistance with preparation of the English manuscript.

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