Function and Dysfunction of the Sinus Node: Clinical Studies in the Evaluation of Sinus Node Function

  • Jay L. Jordan
  • Iwao Yamaguchi
  • William J. Mandel

Abstract

The sick sinus syndrome is a descriptive term coined by Lown (1966) and popularized by Ferrer (1968), referring to a constellation of clinical signs, symptoms, and electrocardio-graphic (ECG) criteria defining sinus node dysfunction. The syndrome is characterized by syncope or other manifestations of cerebral dysfunction in association with sinus brady-cardia, sinus arrest, sinoatrial block, alternating bradyarrhythmias and tachyarrhythmias and/or carotid hypersensitivity. Clinical signs and symptoms, however, result from failure of escape pacemaker function not from sinus node malfunction per se (Mandel and Laks, 1974); thus, the sick sinus syndrome may represent a generalized disorder of the conduc- tion system.

Keywords

Cardiol Propranolol Bark Verapamil Rosen 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abbott, J.P., Kunkel, F., Hirschfeld, D.S., Scheinman, M.M.: Effects of cardiac pacing and heart rate acceleration on exercise-induced symptoms in patients with sick sinus syndrome. Circulation 49 and 50: 111–119, 1974Google Scholar
  2. Amory, D.W., West, T.C.: Chronotropic response following direct electrical stimulation of the isolated sinoatrial node: A pharmacological evaluation. J Pharmacol Exptl Therap 137; 14, 1962Google Scholar
  3. Arguss, N.S., Rosin, E.Y., Adolph, A.J., Fowler, NO.: Significance of chronic sinus bradycardia in elderly people. Circulation 46: 924, 1972Google Scholar
  4. Balke, B., Ware, R.W.: An experimental study of physical fitness of air force personnel. US. Armed Forces MedJ lO: 675, 1959Google Scholar
  5. Barks, J.B., Bosman, C.K., Cochrane, J.W.C.: Congenital cardiac arrhythmias. Lancet 2: 531, 1964Google Scholar
  6. Bashour, T., Hemb, R., Wickramesekaran, R., Strauss, H.C., Bigger, J.T., Jr.: An unusual effect of atropine on overdrive suppression. Circulation 48: 911, 1973PubMedGoogle Scholar
  7. Beiser, G.D., Epstein, S.E., Stampfer, M., Goldstein, R.E.: Impaired heart rate response to sympathetic nerve stimulation in patients with cardiac decompensation. Circulation 38: VI–40, 1968Google Scholar
  8. Bigger, J.T.: A simple, rapid method for the diagnosis of first-degree sinoatrial block in man. Am Heart J 87: 731, 1974PubMedCrossRefGoogle Scholar
  9. Bigger, J.T.: The sick sinus syndrome. Prac Cardiol 3: 66, 1977Google Scholar
  10. Bond, R.C., Engel, T.R., Schaal, S.F.: Effect of digitalis on sinoatrial conduction in man (abstract). Am J Cardiol 33: 128, 1974CrossRefGoogle Scholar
  11. Bonke, F.I.M., Bouman, L.N., Van Rijn H.E.: Change of cardiac rhythm in the rabbit after an atrial premature beat. Circ Res 24: 533, 1969PubMedGoogle Scholar
  12. Bonke, F.I.M., Bouman, L.N., Schopman, F.J.G.: Effect of an early atrial premature beat on activity of the sinoatrial node and atrial rhythm in the rabbit. Circ Res 24: 704, 1971Google Scholar
  13. Brasil, A.: Autonomic sinoatrial block. A new disturbance of the heart mechanism. Arquivos Brasileiras de Cardiologia 8: 159, 1955Google Scholar
  14. Breithardt, G., Seipel, L.: The effect of premature atrial depolarization on sinus node automaticity in man. Circulation 53: 920, 1976PubMedGoogle Scholar
  15. Breithardt, G., Seipel, L., Both, A., Loogen, F.: The effect of atropine ofcalculated sinoatrial conduction time in man. Eur J Cardiol 4: 49, 1976PubMedGoogle Scholar
  16. Breithardt, G., Seipel, L., Loogen, F.: Sinus node recovery time and calculated sinoatrial conduction time in normal subjects and patients with sinus node dysfunction. Circulation 56: 43, 1977PubMedGoogle Scholar
  17. Brooks, C./McC., Lu, H.-H.: The sinoatrial pacemaker of the heart. Charles C. Thomas, Publishing Co., Springfield, Illinois, p. 109–110, 1972Google Scholar
  18. Chadda, K.D., Banke, V.S., Bodenheimer, M.M., Helfant, R.H.: Corrected sinus node recovery time: Experimental, physiological and pathologic determinents. Circulation 51: 797, 1975PubMedGoogle Scholar
  19. Childers, R.W., Arnsdorf, M.F., de la Fuente, D.J., Gambetta, M., Svenson, R.: Sinus node echoes. Am J Cardiol 31: 220, 1973PubMedCrossRefGoogle Scholar
  20. Cohen, A.E., Lewis, T.: Auricular fibrillation and complete heart block: A description of a case of Adams-Stokes syndrome including the postmortem examination. Heart 4: 15, 1912Google Scholar
  21. Cohn, A.E., Lewis, T.: Auricular fibrillation and complete heart block. A description of a case of Adams-Stokes syndrome including the postmortem examination. Heart 4: 15, 1913Google Scholar
  22. Conde, C., Leppo, J., Lipski, J., Stimmel, B., Litwak, R., Donoso, E., Dack, S.: Effectiveness of pacemaker treatment in the bradycardiatachycardia syndrome. Am J Cardiol 32: 209, 1973PubMedCrossRefGoogle Scholar
  23. Corday, E., Bazika, V., Lang, T.W., Pappelbaum, S., Gold, H., Berstein, H.: Detection of phantom arrhythmias and evanescent ECG abnormalities. JAMA 193: 417, 1965PubMedGoogle Scholar
  24. Covell, J.W., Chidsey, C.A., Braunwald, E.: Reduction of the cardiac responses to postganglionic sympathetic nerve stimulation in patients with cardiac decompensation. Circ Res 19: 51, 1966Google Scholar
  25. Crook, B.R.M., Cashman, P.M.M., Stott, F.D., Raftery, E.B.: Tape monitoring of the electrocardiogram in ambulant patients with sinoatrial disease. Br Heart J 35: 1009, 1973PubMedCrossRefGoogle Scholar
  26. Dauchat, P., Gravenstein, J.S.: Effects of atropine on the electrocardiogram in different age groups. Clin Pharmacol Therap 12: 274, 1974Google Scholar
  27. Davies, M.J., Pomerance, A.: Quantitative study of aging changes in the human sinoatrial node and internodal tracts. Br Heart J 34: 150, 1972PubMedCrossRefGoogle Scholar
  28. Denes, P., Delon, W., Dhingra, R.: The effects of cycle length on cardiac refractory periods in man. Circulation 49: 32, 1974PubMedGoogle Scholar
  29. Dhingra, R.C., Wyndham, C., Amat-y-Leon, F., Denes, P., Wu, D., Rosen, K.M.: Sinus nodal responses to atrial extra-stimuli in patients without apparent sinus node disease. Am J Cardiol 36: 445, l975aCrossRefGoogle Scholar
  30. Dhingra, R.C., Amat-y-Leon, F., Wyndam, C., Denes, P., Wu, D, Pouget, J.M., Rosen, K.M.: Electrophysiologic effects of atropine on human sinus node and atrium. Am J Cardiol 38: 429, 1976aPubMedCrossRefGoogle Scholar
  31. Dhingra, R.C., Amat-y-Leon, F., Wyndham, C., Wu, D., Denes, P., Rosen, K.M.: The electrophysiological effects of ouabain on sinus node and atrium in man. J Clin Invest, 56: 555, l975bCrossRefGoogle Scholar
  32. Dhingra, R.C., Amat-y-Leon, F., Wyndham, C., Denes, P., Wu, D., Miller, R.H., Rosen, K.M.: Electrophysiologic effects of atropine on sinus node and atrium in patients with sinus node dysfunction. Am J Cardiol 38: 848, 1976bPubMedCrossRefGoogle Scholar
  33. Dhingra, R.C., Amat-y-Leon, F., Wyndham, C., Deedwania, P.C., Wu, D., Denes, P., Rosen, K.: Clinical significance of prolonged sinoatrial conduction time. Circulation 55: 8, 1977PubMedGoogle Scholar
  34. Dighton, D.H.: Sinus bradycardia: Autonomic influences and clinical assessment. Br Heart J 36: 791, 1974PubMedCrossRefGoogle Scholar
  35. Dighton, D.H.: Sinoatrial block: Autonomic influences and clinical assessment. Br Heart J 37: 321, 1975PubMedCrossRefGoogle Scholar
  36. Eckberg, D.L., Drabinsky, M., Braunwald, E.: Defective cardiac parasympathetic control in patients with heart disease. New Engl J Med 285: 877, 1971PubMedCrossRefGoogle Scholar
  37. Ellestad M.H.: Stress testing: Principles and practice. F.A. Davis, Publishing Co., Philadelphia Penn., p. 38, 1975Google Scholar
  38. Engel, T.R., Schaal, S.F.: Digitalis in the sick sinus syndrome: The effects of digitalis on sinoatrial automaticity and atrioventricular conduction. Circulation 48: 1201, 1973PubMedGoogle Scholar
  39. Engel, T.R., Meister, S.G., Feitosa, G.S., Fisher H.A., Franki, W.S.: Appraisal of sinus node artery disease. Circulation 52: 286, 1975PubMedGoogle Scholar
  40. Engel, T.R., Bond, R.C., Schaal, S.F.: First-degree sinoatrial heart block: Sinoatrial block in the sick sinus syndrome. Am Heart J 91: 303, 1976PubMedCrossRefGoogle Scholar
  41. Ferrer, M.I.: The sick sinus syndrome in atrial disease. JAMA 206: 645, 1968PubMedCrossRefGoogle Scholar
  42. Fisch, C., Greenspan, K., Knobel, SB., Feigenbaum, H.: Effect of digitalis on conduction of the heart. Frog Cardiovasc Dis 6: 343, 1964CrossRefGoogle Scholar
  43. Furchgott, R.F., Dc Gubaroff, T., Grossman, A.: Release of autonomic mediators in cardiac tissue by suprathreshold stimulation. Science 129: 328, 1959PubMedCrossRefGoogle Scholar
  44. Fraser, G.R., Froggatt, P., James, TN.: Congenital deafness associated with electrocardiographic abnormalities, fainting attacks and sudden death: A recessive syndrome. Quart J Med 33: 361, 1964PubMedGoogle Scholar
  45. George, C.F., Conolly, M.E., Briant, F., Dollery, C.T.: Intravenously administered isoproterenol sulfate: Dose-response curves in man. Arch Int Med 30: 361, 1972CrossRefGoogle Scholar
  46. Goldberg, A.N., Moran, J.F., Resnekov, L.: Multistage electrocardiographic tests. Am J Cardiol 26: 84, 1970CrossRefGoogle Scholar
  47. Goldreyer, B.N., Damato, AN.: Sinoatrial node entrance block. Circulation 44: 789, 1971PubMedGoogle Scholar
  48. Goldstein, R.E., Beiser, D.G., Stampfer, M., Epstein, S.E.: Impairment of autonomically mediated heart rate control in patients with cardiac dysfunction. Circ Res 36: 571, 1975PubMedGoogle Scholar
  49. Goodman, D.J., Rosen, R.M., Ingham, R., Rider, A.K., Harrison, D.C.: Sinus node function in the deverated human heart. Effect of digitalis. Br Heart J 37: 612, 1975PubMedCrossRefGoogle Scholar
  50. Gupta, P.K., Lichstein, E., Chadda, K.D., Baduri, E.: Appraisal of sinus nodal recovery time in patients with sick sinus syndrome. Am J Cardiol 34: 265, 1974PubMedCrossRefGoogle Scholar
  51. Hamlin, R.L., Smith, C.R., Smetzer, D.L.: Sinus arrhythmia in the dog. Am J Physiol 210: 321, 1966PubMedGoogle Scholar
  52. Han, J.H., Malozzi, A.M., Moe, G.K.: Sino-atrial reciprocation in the isolated rabbit heart. Circ Res 22: 355, 1968PubMedGoogle Scholar
  53. Hartel, G., Talvensaari, T.: Treatment of sinoatrial syndrome with permanent cardiac pacing in 90 patients. Acta Med Scan 198: 341, 1975CrossRefGoogle Scholar
  54. Hirschfeld, D.S., Peters, R., Kunkel, F., Scheinman, M.M.: Sinoatrial conduction time (SACT) and abnormal perinodal refractoriness in patients with sinus node disease (SND). Circulation 52: II–112, 1975Google Scholar
  55. Hoffman, B.F., Cranefield, P.F.: Electrophysiology of the heart. New York, McGraw-Hill, 1960Google Scholar
  56. Hoffman, B.F., Singer D.H.: Effects of digitalis on electrical activity of cardiac fibers. Frog Cardiovasc Dis 7: 226, 1964CrossRefGoogle Scholar
  57. Holden, W., McAnullty, J., Rahimtoola, S.: Inadequate heart rate response to exercise in the sick sinus syndrome. Circulation 53 and 54: II–146, 1976Google Scholar
  58. James, T.N.: Myocardial infarction and atrial arrhythmias. Circulation 24: 761, 1961PubMedGoogle Scholar
  59. Jordan, J.L., Yamaguchi, I., Mandel, W.J.: The sick sinus syndrome: Pathophysiology, significance and treatment. Cardiol Dig 12: 11, 1977aGoogle Scholar
  60. Jordan, J., Yamaguchi, I., Mandel, W.J., McCullen, A.E.: Comparative effects of overdrive on sinus and subsidiary pacemaker function. Am Heart J 93: 367, 1977bPubMedCrossRefGoogle Scholar
  61. Jordan, J.L., Yamaguchi, I., Mandel, W.J.: Characteristics of sinoatrial conduction in patients with coronary artery disease. Circulation 55: 569, 1977cPubMedGoogle Scholar
  62. Jordan, J.L., Yamaguchi, I., Mandel, W.J.: Studies on the mechanism of sinus node dysfunction in the sick sinus syndrome. Circulation, 1977d (in press)Google Scholar
  63. Jose, A.D., Collison, D.: The normal range and determinants of the intrinsic heart rate in man. Cardiovasc Res 4: 160, 1970PubMedCrossRefGoogle Scholar
  64. Kaplin, B.M., Langendorf, R., Lev, M., Pick, A.: Tachycardiabradycardia syndrome (so-called “sick sinus syndrome”). Pathology, mechanisms and treatment. Am J Cardiol 31: 497, 1973CrossRefGoogle Scholar
  65. Klein, H.O., Singer, D.H., Hoffman, B.F.: Effects of atrial premature systoles on sinus rhythm in the rabbit. Circ Res 32: 480, 1973PubMedGoogle Scholar
  66. Konisai, T.: Electrophysiologic consideration on sick sinus syndrome. Japan Circ J 40: 194, 1976CrossRefGoogle Scholar
  67. Kulbertus, H.E., Leval-Rutten, F. de, Demoulin, J.C.: Sino-atrial disease: A report on 13 cases. J Electrocardiol 6: 303, 1973PubMedCrossRefGoogle Scholar
  68. Kulbertus, H.E., Leval-Rutten, F. de, Mary, L., Casters, P.: Sinus node recovery time in the elderly. Br Heart J 37: 420, 1975PubMedCrossRefGoogle Scholar
  69. Lange, G.: Action of driving stimuli from intrinsic and extrinsic sources on in situ cardiac pacemaker tissues. Circ Res 17: 449, 1965PubMedGoogle Scholar
  70. Langendorf, R., Lesser, M.E., Plotkin, P., Levin, B.D.: Atrial parasystole with interpolation: Observations on prolonged sinoatrial conduction. Am Heart J 63: 649, 1962PubMedCrossRefGoogle Scholar
  71. Lown, B.: In 14th Hahnemann symposium on mechanisms and therapy of cardiac arrhythmias, Edited by Dreifus, L., Likoff, W., Moyer, J., Philadelphia, Grune Stratton, 1966, p. 185Google Scholar
  72. Lu, H.H., Lange, G., Brooks, C.McC.: Factors controlling pacemaker action in cells of the siroatrial node. Circ Res 17: 460, 1965PubMedGoogle Scholar
  73. Mandel, W.J., Hayakawa, H., Danzig, R., Marcus, H.S.: Evaluation of sino-atrial node function in man by overdrive suppression. Circulation 44: 59, 1971PubMedGoogle Scholar
  74. Mandel, W.J., Laks M.M.: Overview of the sick sinus syndrome. Chest 66: 223, 1974PubMedCrossRefGoogle Scholar
  75. Mandel, W.J., Laks, M.M., Obayashi, K.: Sinus node function: Evaluation in patients with and without sinus node disease. Arch Int Med 135: 388, 1975CrossRefGoogle Scholar
  76. Masini, 0., Dianda, R., Grazina, A.: Analysis of sinoatrial conduction in man using premature atrial stimulation. Cardiovasc Res 9: 498, 1975PubMedCrossRefGoogle Scholar
  77. Metzger, A.L., Goldberg, A.N., Hunter, R.L.: Sick sinus node syndrome as the presenting manifestation of reticulum cell sarcoma. Chest 60: 602, 1971PubMedCrossRefGoogle Scholar
  78. Miller, H.C., Strauss, H.C.: Measurement of sinoatrial conduction time by premature atrial stimulation in the rabbit. Circ Res 35: 935, 1974PubMedGoogle Scholar
  79. Moss, A.J., Davis, R.J.: Brady-tachy syndrome. Frog Cardiovasc Dis 16: 439, 1974CrossRefGoogle Scholar
  80. Narula, O.S.: Sinus node reentry. A mechanism for supraventricular tachycardia. Circulation 50: 114, 1974Google Scholar
  81. Narula, O.S., Samet, P., Javier, R.P.: Significance of the sinus node recovery time. Circulation 45: 140, 1972PubMedGoogle Scholar
  82. Okimoto, T., Veda, K., Kamata, C., Yoshida, H., Ohkawa, S., Hiracka, K., Kuwajima, I., Sugiura, M., Murakami, M., Matsuo, H.: Sinus node recovery time and abnormal post-pacing phase in the aged patients with sick sinus syndrome. Japan Heart J 17: 290, 1976CrossRefGoogle Scholar
  83. Paritsky, Z., Obayashi, K., Mandel, W.J.: Atrial tachycardia secondary to sino-atrial node reentry. Chest 66: 526, 1974CrossRefGoogle Scholar
  84. Pasmooij, J.H., Van Enst G.C., Bouman, L.N., Allessie, M.A., Bonke, F.I.M.: The effect of heart rate on the membrane responsiveness of rabbit atrial muscle. Pflügers Arch 366: 223, 1976PubMedCrossRefGoogle Scholar
  85. Paulay, K.L., Varghese, P.J., Damato, A.N.: Atrial rhythms in response to an early atrial premature depolarization in man. Am Heart J 85: 323, 1973a.CrossRefGoogle Scholar
  86. Paulay, K.L., Varghese, P.J., Damato, A.N.: Sinus node reentry: An in vivo demonstration in the dog. Circ Res 32: 455, l973bGoogle Scholar
  87. Radford, D.J., Julian, D.G.: Sick sinus syndrome: Experience of a cardiac pacemaker clinic. Br Med J 3: 504, 1974PubMedCrossRefGoogle Scholar
  88. Rasmussen, K.: Chronic sinoatrial heart block. Am Heart J 81: 38, 1971CrossRefGoogle Scholar
  89. Reiffel, J.A., Bigger, J.T., Konstam, M.A.: The relationship between sinoatrial conduction time and sinus cycle length during spontaneous sinus arrhythmia in adults. Circulation 50: 924, 1974PubMedGoogle Scholar
  90. Reiffel, J.P., Bigger, J.T., Giardina, E.-G.V.: “Paradoxical” prolongation of sinus nodal recovery time after atropine in the sick sinus syndrome. Am J Cardiol 36: 98, 1975PubMedCrossRefGoogle Scholar
  91. Rokseth, R., Hatle, L.: Prospective study on the occurrence and management of chronic sinoatrial disease with follow-up. Br Heart J 36: 582, 1974PubMedCrossRefGoogle Scholar
  92. Rosen, K.M., Loeb, H.S., Sinno, M.Z., Rahimtoola, S.H., Gunnar, R.M.: Cardiac conduction in patients with symptomatic sinus node disease. Circulation 43: 836, 1971.PubMedGoogle Scholar
  93. Rosen, M.R., Wit, A.L., Hoffman, B.F.: Electrophysiology and pharmacology of cardiac arrhythmias. IV. Cardiac antiarrhythmic and toxic effects of digitalis. Am Heart J 89: 391, 1975PubMedCrossRefGoogle Scholar
  94. Rubenstein, J.J., Schulman, C.L., Yurchack, P.M., et al.: Clinical spectrum of the sick sinus syndrome. Circulation 46: 5, 1972PubMedGoogle Scholar
  95. Sano, T., Yamagishi, S.: Spread of excitation from the sinus node. Circ Res 16: 423, 1965PubMedGoogle Scholar
  96. Saroff, A., Strauss, H.C., Bigger, J.T., Steiner, C., Giardina, E.-G.V.: Evaluation of sinus node function in patients with sinus bradycardia. Circulation 44: II–97, 1971Google Scholar
  97. Scheinman, M.M., Kunkel, F.W., Peter, R.W., Schoenfeld, P.L., Abbott, J.A.: Sino-atrial function and atrial refractoriness in patients with sick sinus syndrome. Circulation 48: IV–2l5, 1973Google Scholar
  98. Scheinman, M.M., Peter, R., Hirschfeld, D.S., Abbott, J.A., Kunkel, F.W.: The sick sinus and failing atrium. West J Med 121: 473, 1974PubMedGoogle Scholar
  99. Scher, A.M., Rodrigues, M.I., Lukane, J., Young, A.C.: The mechanism of atrio-ventricular conduction. Circ Res 7: 54, 1959PubMedGoogle Scholar
  100. Scherf, D.: The mechanisms of sinoatrial block. Am J Cardiol 23: 769, 1969PubMedCrossRefGoogle Scholar
  101. Scherlag, B.J., Abelleira, J.L., Narula, O.S., Samet, P.: The differential effects of ouabain on sinus, AV nodal, His bundle and idioventricular rhythms. Am Heart J 81: 227, 1971PubMedCrossRefGoogle Scholar
  102. Seipel, L., Both, A., Breithardt, G., Gleichman, U., Loogen, F.: Action of antiarrhythmic drugs on His bundle electrogram and sinus node function. Acta Cardiol XVIII: 251, 1974Google Scholar
  103. Sigurd, B., Jensen, G., Meibom, J., Sandoe, E.: Adams-Stokes syndrome caused by sinoatrial block. Br Heart J 35: 1002, 1973PubMedCrossRefGoogle Scholar
  104. Sowton, E., Hendrix, G., Roy, P.: Ten-year survey of treatment with implanted cardiac pacemaker. Brit Med J 3: 155, 1974PubMedCrossRefGoogle Scholar
  105. Spellberg, R.D.: Familial sinus node disease. Chest 60: 246, 1971PubMedCrossRefGoogle Scholar
  106. Steinbeck, G., Lüderitz, B.: Comparative study of sinoatrial conduction time and sinus node recovery time. Br Heart J 37: 956, 1975PubMedCrossRefGoogle Scholar
  107. Strauss, H.C., Bigger, J.T.: Electrophysiological properties of the rabbit sinoatrial perinodal fibers. Circ Res 31: 490, 1972PubMedGoogle Scholar
  108. Strauss, H.C., Saroff, A.L., Bigger, J.T., Giardina E.-G.V.: Premature atrial stimulation as a key to the understanding of sinoatrial conduction in man. Presentation of data and cirtical review of the literature. Circulation 47: 86, 1973PubMedGoogle Scholar
  109. Strauss, H.C., Saroff, A.L., Bigger, J.T.: Slowed conduction, block and reentry in perinodal fibers. Circulation 43 and 44, suppl. II, 1974Google Scholar
  110. Strauss, H.C., Gilbert, M., Svenson, R., Miller, H.C., Wallace, A.G.: Electrophysiologic effects of propranolol on sinus node function in patients with sinus node dysfunction. Circulation 54: 452, 1976aPubMedGoogle Scholar
  111. Strauss, H.C., Bigger, J.T., Saroff, A.L., Giardina, E.-G.V.: Electrophysiologic evaluation of sinus node function in patients with sinus node dysfunction. Circulation 53: 763, 1976bPubMedGoogle Scholar
  112. Szekeres, L., Papp, G.J.: Experimental cardiac arrhythmias and antiarrhythmic drugs. Budapest, Akademiai Kiado, 1971Google Scholar
  113. Ten Eick, R.E., Hoffman, B.F.: Chronotropic effect on cardiac glycosides in dogs, cats, and rabbits. Circ Res 25: 365, 1969PubMedGoogle Scholar
  114. Toda, N., West, T.C.: Influence of ouabain on chalinergic responses in sonoatrial node. J. Pharmacol Exp Ther 153: 104, 1966PubMedGoogle Scholar
  115. Vincenzi, F.F., West, T.C.: Release of autonomic mediators in cardiac tissue by direct subthreshold electrical stimulation. J Pharmacol Exp Ther 141: 185, 1963PubMedGoogle Scholar
  116. Wan, S.H., Lee, G.S., Ton, C.S.: The sick sinus syndrome. A study of 15 cases. Br Heart J 34: 942, 1972PubMedCrossRefGoogle Scholar
  117. Ward, P.C.: A new familial cardiac syndrome in children. J Irish Med Assoc 54: 103, 1964Google Scholar
  118. Yabek, SM., Jarmakani, J.M., Robert, N.K.: Sinus node function in children. Factors influencing its evaluation. Circ 53: 28, 1976Google Scholar
  119. Yamaguchi, I., Mandel, W.J.: The effect of stimulation site on electrophysiologic features of the sinus node. Am J Cardiol 41: 374, 1978CrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Medical Division 1978

Authors and Affiliations

  • Jay L. Jordan
  • Iwao Yamaguchi
  • William J. Mandel

There are no affiliations available

Personalised recommendations