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Sino‐Atrial Dissociation: Evidence by Intracardiac Recordings in Man and by Microelectrode Studies on Isolated Rabbit Atrium
Author(s) -
PISAPIA ANDRÉ,
LEHEUZEY JEAN YVES,
FAURE JACQUES,
SIMONETTI BERNARD,
SZATMARY LASZLO,
CARTA MIREILLE,
ROSARIO ROGER,
BARNAY CLAUDE,
DUPORT GUY
Publication year - 1988
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1988.tb03927.x
Subject(s) - medicine , sinus (botany) , intracardiac injection , cardiology , atrium (architecture) , sinoatrial node , electrophysiology , sick sinus syndrome , anatomy , atrial fibrillation , heart rate , botany , blood pressure , biology , genus
The electrophysiologic mechanisms of sinus dysfunction have recently been determined by direct recording of the sinus node electrogram. The association of various degrees of abnormalities in the formation of the impulse within the sinus node and of sinoatrial conduction block, represents the pathophysiological substrate of the mechanism of sinus node dysfunction. The purpose of this work is to present clinical and experimental data supporting the concept of sinus node isolation. In our clinical case, the sinus node was probably intact despite aspects of sinus node dysfunction on the surface ECG. Sinus node electrograms were recorded with a sinoatrial conduction time of 100 ms (normal values in our laboratory: 83 ms ± 38 ms). Atrial mapping demonstrated that (he area depolarized by the sinus node involved a 2 cm 2 zone surrounding it. This perisinusal activity could not be recorded on the surface ECG. Both exit and entry blocks in the sinus node were demonstrated. Our experimental data showed a total desynchronization between the electrical activity of the sinus node and that of the atrium under hypoxic conditions. Both types of cases demonstrated that an atrial dysrhythmia was coexisting with regular sinus activity. From these data we concluded that a sinus node free from any pathological involvement could be associated with severe symptoms of sinus node dysfunction on the surface ECG.