Sinus Node Recovery Time and Abnormal Postpacing Phase in the Aged Patients with Sick Sinus Syndrome

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  • OKIMOTO Takao
    Cardiovascular Division, Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • UEDA Keiji
    Cardiovascular Division, Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • KAMATA Chizuko
    Cardiovascular Division, Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • YOSHIDA Hiromi
    Cardiovascular Division, Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • OHKAWA Shin-ichiro
    Cardiovascular Division, Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • HIRAOKA Keisuke
    Cardiovascular Division, Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • KUWAJIMA Iwao
    Cardiovascular Division, Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • SUGIURA Masaya
    Cardiovascular Division, Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • MURAKAMI Mototaka
    Cardiovascular Division, Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • MATSUO Hiroshi
    Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo

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タイトル別名
  • Sinus node recovery time and abnormal p

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The sinus node function was evaluated by rapid atrial pacing in 35 aged patients (mean age 78.2 years) including 10 aged controls, 12 cases with various degrees of AV block, 6 with bradycardia-tachycardia syndrome (BTS), and 7 with sinus bradyarrhythmia (SB). AV block was further divided into A-H block (7 cases) and H-V block (5 cases) by His bundle electrogram which was simultaneously recorded with 3 leads of surface electrocardiogram. <br>Sinus node recovery time (SRT) was measured and its maximum value (SRTmax) was selected from SRTs obtained after pacing with various rates and durations in each patient. SRTmax was also expressed as percentage of the control P-P interval (%SRTmax). <br>For patients in whom the study was repeated 3 to 8 months later, %SRTmax was reproducible in 9 of 14 instances. Prolongation of SRT was not always observed as the rate and/or duration of pacing was increased. SRTmax and %SRTmax were 1, 363±188msec and 147±19% (mean±SD), respectively, for aged controls, 1, 597±442msec and 156±31% for patients with AV block, 2, 087±1, 315msec and 203±132% for those with BTS, and 3, 069±1, 287msec and 247±115% for those with SB. SRTmax exceeding the range for aged controls was noted in 4 of 7 cases (57%) with A-H block, 2 of 6 (33%) with BTS, and 5 of 7 (71%) with SB; normal SRT was not infrequently observed in patients with sick sinus syndrome, especially in those with BTS. <br>Analysis of 10 consecutive atrial cycles following cessation of pacing revealed that in 8 cases the first P-P interval (SRT) was followed by longer ones in some occasions (secondary suppression). It was observed almost exclusively in patients with sick sinus syndrome. The possibility of this phenomenon to reflect another feature of sinus node abnormality was discussed.

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