The Sinoatrial Node and Its Dysfunction

  • John D. Kugler
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 56)


The purpose of this chapter is to review the function and dysfunction of the sinoatrial node (SAN). The majority of the chapter encompasses SAN dysfunction: surface electrocardiography; clinical manifestations; noninvasive evaluation; intracardiac electrophysiology and treatment. It is essential, however, to understand the normal function of the SAN. Therefore, before proceeding to a discussion of the clinical study of the SAN and its dysfunction, the embryological development, ultrastructure and cellular electrophysiology are reviewed. A solid background will therefore be available for a discussion of new directions in pediatric SAN electrocardiography.


Sinus Node Great Artery Sinoatrial Node Sick Sinus Syndrome Sinus Node Dysfunction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Van Mierop LHS, Gessner IH. The morphologic development of the sinoatrial node in the mouse. Am J Cardiol 25:204, 1970.PubMedGoogle Scholar
  2. 2.
    Anderson RH, Wenink ACG, Becker AE, Janse MJ. Development of the specialized tissues. In HJJ Wellens, KI Lie, MJ Janse (eds.), Conduction System of the Heart: Structure, Function and Clinical Implications, Leiden: Stenfert Krose, 1, 1976, p. 1.Google Scholar
  3. 3.
    Anderson RH, Yen HS, Becker AE, Gosling JA. The development of the sinoatrial node. In FIM Bonke (ed.), The Sinus Node. The Hague/ Boston/London: Martinus Nijhoff, 1978, p. 166.Google Scholar
  4. 4.
    Keith A, Flack MW. The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol 41:171, 1907.Google Scholar
  5. 5.
    Lev M, Watne AL. Method for routine histopathologic study of human sinoatrial node. Arch Path 57:168, 1954.Google Scholar
  6. 6.
    James TN. Anatomy of the human sinus node. Anato Rec 141:109, 1961.Google Scholar
  7. 7.
    Becker AE. General comments. In FIM Bonke (ed.), The Sinus Node, The Hague/ Boston/London: Martinus Nijhoff, 1978, p. 212.Google Scholar
  8. 8.
    Kyriakidis MK, Kourouklis CB, Papaioannou JT, Christakos SG, Spanos GP, Avgoustakis DG. Sinus node coronary arteries studied with angiography. Am J of Cardiol 51:749, 1983.Google Scholar
  9. 9.
    Anderson KR, Ho SY, Anderson RH. Location and vascular supply of sinus node in human heart. Br Heart J 41:28, 1979.PubMedGoogle Scholar
  10. 10.
    Yamauchi A. Ultrastructure of the innervation of the mammalian heart. In CE Challice, S Viragh (eds.), Ultrastructure of the Mammalian Heart. New York: Academic Press, 1973, p. 127.Google Scholar
  11. 11.
    Tranum-Jensen J. The fine structure of the sinus node: A survey. In FIM Bonke (ed.), The Sinus Node. The Hague: Martinus Nijhoff, 1978, p. 149.Google Scholar
  12. 12.
    James TN. The sinus node as a servomechanism. Circ Res 32:307, 1973.PubMedGoogle Scholar
  13. 13.
    James TN. The sinus node. Am J Cardiol 40:965, 1977.PubMedGoogle Scholar
  14. 14.
    Masson-Pevet M, Bleeker WK, Gros D. The plasma membrane of leading pacemaker cells in the rabbit sinus node: A qualitative and quantitative ultrastructural analysis. Circ Res 45:621, 1979.PubMedGoogle Scholar
  15. 15.
    James TN, Sherf L, Fine G, Morales AR. Comparative ultrastructure of the sinus node in man and dog. Circulation 34:139, 1966.PubMedGoogle Scholar
  16. 16.
    Kawamura K, James TN. Comparative ultrastructure of cellular junctions in working myocardium and the conducting system under normal and pathologic conditions. J Mol Cell Cardiol 3:31, 1971.PubMedGoogle Scholar
  17. 17.
    Trautwien W, Uchizoro K. Electromicroscopic and electrophysiologic study of the pacemaker cell in the sinoatrial node of the rabbit heart. Zeot fur Zell 61:96, 1963.Google Scholar
  18. 18.
    Rhodin JAG, Del Missier P, Reid LC. The structure of the specialized impulse conducting system of the steer heart. Circulation 24:349, 1961.Google Scholar
  19. 19.
    Irisawa A. Fine structure of the small sinoatrial node specimen used for the voltage clamp experiment. In FIM Bonke (ed.) The Sinus Node: Structure, Function, and Relevance. The Hague: Martinus Nijhoff Medical Division, 1978, p. 311.Google Scholar
  20. 20.
    Beder SD. Cellular electrophysiology of the sinus node. In SM Yabek, PC Gillette, JD Kugler, (eds.), The Sinus Node in Pediatrics, Churchill Livingstone, 1984, p. 18.Google Scholar
  21. 21.
    Hoffman BF, Cranefield PC. Electrophysiology of the Heart. Mount Kisco, NY: Futura Publishing Company, 1976.Google Scholar
  22. 22.
    Lipsius SL, Vassalle M. Characterization of a two-component upstroke in the sinus node subsidiary pacemakers. In FIM Bonke (ed.), The Sinus Node: Structure, Function and Relevance. The Hague: Martinus Nijhoff Medical Division, 1978, p. 233.Google Scholar
  23. 23.
    Bleeker WK, Mackaay AJC, Masson-Pevet M, Bouman LN, Becker AE. Functional and morphological organization of the rabbit sinus node. Circ Res 46:11, 1980.PubMedGoogle Scholar
  24. 24.
    Bouman LN, Mackaay AJC, Bleeker WR, Becker AE. Pacemaker shifts in the sinus node: Effects of vagal stimulation, temperature and reduction of extracellular calcium. In FIM Bonke (ed.), The Sinus Node: Structure, Function and Relevance. The Hague: Martinus Nijhoff Medical Division, 1978, p. 245.Google Scholar
  25. 25.
    Bonke FIM. A general introduction about the current status of the electrophysiology of the sinus node. In The Sinus Node: Structure, Function, and Relevance. The Hague: Martinus Nijhoff Medical Division, 1978, p. 225.Google Scholar
  26. 26.
    Litwin J, Skolasinski K. On the mechanism for bradycardia induced by acute systemic anoxia in the dog. Pfluegers Archives 289:109, 1966.Google Scholar
  27. 27.
    Reder RF, Rosen MR. Basic electrophysiologic principles: Application to treatment of dysrhythmias. In PC Gillette, Jr A Garson (ed.), Pediatric Cardiac Dysrhythmias. New York: Grune and Stratton, 1981, p. 121.Google Scholar
  28. 28.
    Southall DP, Richards JM, Rhoden DJ, Alexander JR, Shinebourne EA, Arrowsmith WA, Cree JE, Fleming PJ, Goncalves A, Orme RLE. Prolonged apnea and cardiac arrhythmias in infants discharged from neonatal intensive care units: Failure to predict an increased risk for sudden infant death syndrome. Pediatrics 70:844, 1982.PubMedGoogle Scholar
  29. 29.
    Kugler JD, Yabek SM. Sick sinus syndrome: Clinical features and noninvasive evaluation. In SM Yabek, PC Gillette, JD Kugler (eds.), The Sinus Node in Pediatrics, Churchill Livingstone, 1984, p. 48.Google Scholar
  30. 30.
    Kugler JD. Sinoatrial node dysfunction. In PC Gillette Jr A Garson (eds.), Pediatric Cardiac Dysrhythmias. New York: Grune and Stratton, 1981, p. 265.Google Scholar
  31. 31.
    Urthaler F, Katholi CR, Macy J Jr, James TN. Mathematical relationship between automaticity of the sinus node and the AV junction. Am Heart J 86:189, 1973.PubMedGoogle Scholar
  32. 32.
    Kugler JD, Pinsky WW, Cheatham JP, Hofschire PJ. Atrial muscle tachydysrhythmia in the young. J Am Coll Cardiol (Abstract) 1:614, 1983.Google Scholar
  33. 33.
    Mandel WJ, Laks MM. Overview of the sick sinus syndrome. Chest 66:223, 1974.PubMedGoogle Scholar
  34. 34.
    Ferrer MI. Physiologic manifestations of the sick sinus syndrome. In MI Ferrer (ed.), The Sick Sinus Syndrome. Mt. Kisco, NY: Futura Publishing Company, 1974, p. 37.Google Scholar
  35. 35.
    Yabek SM, Jarmakani JM. Sinus node dysfunction in children, adolescents and young adults. Pediatrics 61:593, 1978.PubMedGoogle Scholar
  36. 36.
    Kugler JD, Garson A Jr, Gillette PC. Electrophysiologic effect of digitalis on sinoatrial nodal function in children. Am J Cardiolo 44:1344, 1979.Google Scholar
  37. 37.
    Engel TR, Schaal SF. Digitalis in the sick sinus syndrome: The effects of digitalis on sinoatrial automaticity and atrioventricular conduction. Circulation 48:1201, 1973.PubMedGoogle Scholar
  38. 38.
    Yabek SM, Berman W Jr, Dillon T. Electrophysiologic effects of propranolol on sinus node function in children. T Am Heart J 104:612, 1982.Google Scholar
  39. 39.
    Carrasco HA, Fuenmayor AP, Barboza JSM, Gonzalez G. Effect of Verapamil on normal sinoatrial node function and on sick sinus syndrome. Am Heart J 96:760, 1978.PubMedGoogle Scholar
  40. 40.
    Breithardt G, Seipel L, Wiebringhaus E. Dual effect of verapamil on sinus node function in man. In The Sinus Node, The Hague/Boston/London: Martinus Nijhoff, 1978, p. 129.Google Scholar
  41. 41.
    Valette H, Barnay C, Lopez M, Hebert JL, Gallet M, Apoil E, Moyse D, Medvedowsky JL. Effects of intravenous diltiazem on sinus node function and atrioventricular conduction in patients. J of Cardiovas Pharmacol 5:62, 1983.Google Scholar
  42. 42.
    Calon AH, Ticzon AR, Akhtar M, Reddy CP, Leeds C, Damato AN. Quinidine in sinus node dysfunction. Circulation (Abstract) 54:II-231, 1976.Google Scholar
  43. 43.
    LaBarre A, Strauss HC, Scheinman MM, Evans GT, Bashore T, Tiedeman JS, Wallace AG. Electrophysiologic effects of disopyramide phosphate on sinus node function in patients with sinus node dysfunction. Circulation 59:226, 1979.PubMedGoogle Scholar
  44. 44.
    Goldberg D, Reiffel JA, Davis JC, Gang E, Livelli F, Bigger JT Jr. Electrophysiologic effects of procainamide on sinus function in patients with and without sinus node disease. Am Heart J 103:75, 1982.PubMedGoogle Scholar
  45. 45.
    Lieberman NA, Harris RS, Katz RI, Lipschutz HM, Dolgin M, Fisher VJ. The effects of lidocaine on the electrical and mechanical activity of the heart. Am J Cardiol 22:375, 1968.PubMedGoogle Scholar
  46. 46.
    Lippestad CT, Forfang K. Production of sinus arrest by lignocaine. Br Med J 1:537, 1971.PubMedGoogle Scholar
  47. 47.
    Keidar S, Grenadier E, Palant A. Sinoatrial arrest due to lidocaine injection in sick sinus syndrome during amiodarone administration. Am Heart J 104:1384, 1982.PubMedGoogle Scholar
  48. 48.
    Touboul P, Atallah G, Gressard A, Kirkorian G. Effects of amiodarone on sinus node in man. Br Heart J 42:573, 1979.PubMedGoogle Scholar
  49. 49.
    Saksena A, Rothbart S, Kaufmann WE, Rathyen W. Chronic electrophysiologic, systemic and pharmacologic effects of amiodarone in recurrent ventricular tachycardia. Am J of Cardiol (Abstract) 49:1044, 1982.Google Scholar
  50. 50.
    Kugler JD. Effects of pharmacologic agents on sinus node function. In SM Yabek, PC Gillette, JD Kugler (eds.), The Sinus Node in Pediatrics. Churchill Livingstone, 1984, p. 89.Google Scholar
  51. 51.
    Caralis DG, Varghese PJ. Familial sinoatrial node dysfunction: Increased vagal tone a possible etiology. Br Heart J 38:951, 1976.PubMedGoogle Scholar
  52. 52.
    Hariman RJ, Hoffman BF. Effects of ouabain and vagal stimulation on sinus nodal function in conscious dogs. Circ Res 51:760, 1982.PubMedGoogle Scholar
  53. 53.
    Hariman RJ, Hoffman BF. Ouabain effects on sinus node function in conscious dogs. Circulation (Abstract) 57, 58:II-106, 1978.Google Scholar
  54. 54.
    Yabek SM, Dillon T, Berman W Jr, Niland CJ. Symptomatic sinus node dysfunction in children without structural heart disease. Pediatrics 69:590, 1982.PubMedGoogle Scholar
  55. 55.
    Beder SD, Gillette PC, Garson A Jr, McNamara DG Nonsurgical sick sinus syndrome in children. Circulation (Abstr) 66:11–316, 1982.Google Scholar
  56. 56.
    Fraser GR, Froggatt P, James TN. Congenital deafness associated with electrocardiographic abnormalities, fainting attacks and sudden death: a recessive syndrome. Quart J Med 33:361, 1964.PubMedGoogle Scholar
  57. 57.
    James TN. Congenital deafness and cardiac arrhythmias. Am J of Cardiol 19:627, 1967.Google Scholar
  58. 58.
    Spellberg RD. Familial sinus node disease. Chest 60:246, 1971.PubMedGoogle Scholar
  59. 59.
    Nordenberg A, Varghese PJ, Nugent EW. Spectrum of sinus node dysfunction in two siblings. Am Heart J 91:507, 1976.PubMedGoogle Scholar
  60. 60.
    Lehmann H, Klein VE. Familial sinus node dysfunction with autosomal dominant inheritance. Br Heart J 40:1314, 1978.PubMedGoogle Scholar
  61. 61.
    Mackintosh AF, Chamberlain DA. Sinus node disease affecting both parents and both children. Eur J Cardiol 1012:117, 1979.Google Scholar
  62. 62.
    Beder SD, Gillette PC. Non-surgical etiologies of sick sinus syndrome. In SM Yabek, PC Gillette, JD Kugler (eds.), The Sinus Node in Pediatrics. Churchill Livingstone, 1984, p. 121.Google Scholar
  63. 63.
    James TN, Froggatt P, Marshall TK. Sudden death in young athletes. Ann Int Medicine 67:1013, 1967.Google Scholar
  64. 64.
    Bharati S, Nordenberg A, Bauernfiend R, Varghese JP, Carvalho AG, Rosen K, Lev M. The anatomic substrate for the sick sinus syndrome in adolescence. Am J Cardiol 46:163, 1980.PubMedGoogle Scholar
  65. 65.
    Ferrer MI (ed.). The Sick Sinus Syndrome. Mt. Kisco, NY: Futura Publishing Co., 1974, p.31.Google Scholar
  66. 66.
    Lenox CC, Zuberbuhler JR, Park SC, Neches WH, Mathews RA, Zltun R. Arrhythmias and Stokes-Adams attacks in acute rheumatic fever. Pediatrics 61:599, 1978.PubMedGoogle Scholar
  67. 67.
    James TN. An etiologic concept concerning the obscure myocardiopathies. Prog Cardiovas Dis 7:43, 1964.Google Scholar
  68. 68.
    Radford DJ, Izukawa T. Sick sinus syndrome: Symptomatic cases in children. Arch Dis Child 50:879, 1975.PubMedGoogle Scholar
  69. 69.
    Clark EB, Kugler JD. Preoperative secundum atrial septal defect with coexisting sinus node and atrioventricular node dysfunction. Circulation 65:976, 1982.PubMedGoogle Scholar
  70. 70.
    Clark EB, Roland J, Varghese PJ, Neill CN, Haller JA Jr. Should the sinus venosus type ASD be closed? A review of atrial conduction defects and surgical results in 28 children. Am J Cardiol (Abstract) 35:127, 1975.Google Scholar
  71. 71.
    Nugent EW, Varghese PJ, Pieroni DR, Rowe RD. “Sluggish” sinus node syndrome as a part of congenital heart disease, abstracted. Am J Cardiol 33:160, 1974.Google Scholar
  72. 72.
    Harper R, Peter T, Vohra J, Hunt D, Sloman G. Sinus node dysfunction and carotid sinus syncope associated with a Wolff-Parkinson-White syndrome. Europ J Cardiol 2:207, 1974.Google Scholar
  73. 73.
    Dreifus LS, Wellens HJ, Watanabe Y, et al. Sinus bradycardia and atrial fibrillation associated with the Wolff-Parkinson-White syndrome. Am J Cardiol 38:149, 1976.PubMedGoogle Scholar
  74. 74.
    Berry EM, Hasin Y. Propranolol-induced dysfunction of the sinus node in Wolff-Parkinson-White syndrome. Chest 73:873, 1978.PubMedGoogle Scholar
  75. 75.
    Rokovec P, Rode P, Jakopin J, Horvat M. Latent sinoatrial conduction disturbances in symptomatic patients with Wolff-Parkinson-White syndrome. PACE 6:2, 1983.Google Scholar
  76. 76.
    Gillette PC, Shannon C, Garson A Jr, Porter CJ, Ott D, Cooley DA, McNamara DG. Pacemaker treatment of sick sinus syndrome in children. J Am Coll Cardiol 1:1325, 1983.PubMedGoogle Scholar
  77. 77.
    Lie JT, Rosenberg HS, Erickson EE. Histopathology of the conduction system in the sudden infant death syndrome. Circulation 53:3, 1976.PubMedGoogle Scholar
  78. 78.
    Cole S, Lindenberg LB, Galioto FM Jr, Howe PE, DeGraff AC Jr, Davis JM, Lubka R, Gross EM. Ultrastructural abnormalities of the carotid body in sudden infant death syndrome. Pediatrics 63:13, 1979.PubMedGoogle Scholar
  79. 79.
    Shannon DC, Kelly DH. SIDS and near SIDS. N Engl J Med 306:959, 1982.PubMedGoogle Scholar
  80. 80.
    Shannon DC, Kelly DH. SIDS and near SIDS. N Engl J Med 306:1022, 1982.PubMedGoogle Scholar
  81. 81.
    Steinschneider A, Weinstein SL, Diamond E. The sudden infant death syndrome and apnea/ obstruction during neonatal sleep and feeding. Pediatrics 70:858, 1982.PubMedGoogle Scholar
  82. 82.
    Anderson RH, Bouton J, Burrow CT, Smith A. Sudden death in infancy: A study of cardiac specialized tissue. Br Med J 2:135, 1974.PubMedGoogle Scholar
  83. 83.
    Anderson KR, Hill RW. Occlusive lesions of cardiac conduction tissue arteries in sudden infant death syndrome. Pediatrics 69:50, 1982.PubMedGoogle Scholar
  84. 84.
    Kozakewich HPW, McManus B, Vawter GF. The sinus node in sudden infant death syndrome. Circulation 65:1242, 1982.PubMedGoogle Scholar
  85. 85.
    Aberdeen E, Waterston DJ, Carr I, Graham G, Bonham-Carter RE, Subramanian S. Successful “correction” of transposed great arteries by Mustard’s operation. Lancet 1:1233, 1965.PubMedGoogle Scholar
  86. 86.
    Khoury GH, Shaher RM, Fowler RS, Keith JD. Preoperative and postoperative electrocardiogram in complete transposition of the great vessels. Am Heart J 72:199, 1966.PubMedGoogle Scholar
  87. 87.
    Zuberbuhler JR, Bauersfeld SR. Unusual arrhythmias after corrective surgery for transposition of the great vessels. Am Heart J 73:752, 1967.PubMedGoogle Scholar
  88. 88.
    Waldhausen JA, Pierce WS, Rashkind WJ, Miller WW, Friedman S. Total correction of transposition of the great arteries following balloon atrial septostomy. Circulation 41:123, 1970.Google Scholar
  89. 89.
    El-Said G, Rosenberg HS, Mullins CE, Hallman GL, Cooley DA, McNamara DG. Dysrhythmias after Mustard’s operation for transposition of the great arteries. Am J Cardiol 30:526, 1972.PubMedGoogle Scholar
  90. 90.
    Gillette PC, El-Said GM, Sivarajan N, Mullins CE, Williams RL, McNamara DG. Electrophysiological abnormalities after Mustard’s operation for transposition of the great arteries. Br Heart J 36:186, 1974.PubMedGoogle Scholar
  91. 91.
    Clarkson PM, Barratt-Boyes BG, Neutze JM. Late dysrhythmias and disturbances of conduction following Mustard operation for complete transposition of the great arteries. Circulation 53:519, 1976.PubMedGoogle Scholar
  92. 92.
    El-Said GM, Gillette PC, Cooley DA, Mullins CE, McNamara DG. Protection of the sinus node in Mustard’s operation. Circulation 53:788, 1976.PubMedGoogle Scholar
  93. 93.
    Kugler JD, Gillette PC, Mullins CE, McNamara DG. Sinoatrial conduction in children: An index of sinoatrial node function. Circulation 59:1266, 1979.PubMedGoogle Scholar
  94. 94.
    Saalouke MG, Rios J, Perry LW, Shapiro SR, Scott LP. Electrophysiologic studies after Mustard’s operation for d-transposition of the great vessels. Am J Cardiol 41:1104, 1978.PubMedGoogle Scholar
  95. 95.
    Vetter VL, Horowitz LN. Electrophysiologic consequences of Mustard repair of transposition of the great arteries. Am J Cardiol (Abstract) 45:430, 1980.Google Scholar
  96. 96.
    Gillette PC, Kugler JD, Garson A Jr, Gutgesell HP, Duff DF, McNamara DG. Mechanisms of cardiac arrhythmias after the Mustard operation for transposition of the great arteries. Am J Cardiol 45:1225, 1980.PubMedGoogle Scholar
  97. 97.
    Hesslein PS, Gusgesell HP, Gillette PC, McNamara DG. Exercise assessment of sinoatrial node function following the Mustard operation. Am Heart J 103:351, 1982.PubMedGoogle Scholar
  98. 98.
    Flinn CJ, Wolff GS, Campbell RM, Dick M, Casta A, Kugler J, Kavey RE, Hordof A, Hougen T, Borkat G. Natural history of supraventricular rhythms in 182 children following the Mustard operation: A collaborative multi-center study. J Am Coll Cardiol (Abstract) 1:613, 1983.Google Scholar
  99. 99.
    Pieroni DR, Gingell RL, Lewin AN, Vlad P, Subramanian S. Postoperative assessment of senning repair for transposition of the great arteries (TGA). Am J Cardiol (Abstract) 43:346, 1979.Google Scholar
  100. 100.
    Arensman FW, Bostock J, Radley-Smith R, Yacoub MH. Cardiac rhythm and conduction before and after anatomic correction for transposition of the great arteries. Circulation 66:II–316, 1982.Google Scholar
  101. 101.
    Kugler JD. Effect of cardiac surgery for congenital heart disease on sinus node function. In SM Yabek, PC Gillette, JD Kugler (eds.), The Sinus Node in Pediatrics. Churchill Livingstone, 1984, p. 104.Google Scholar
  102. 102.
    Edwards WD, Edwards JE. Pathology of the sinus node in d-transposition following the Mustard operation. J Thorac Cardiovasc Surg 75:213, 1978.PubMedGoogle Scholar
  103. 103.
    Sasaki R, Theilen EO, January LE, Ehrenhaft JL. Cardiac arrhythmias associated with the repair of atrial and ventricular septal defects. Circulation 18:909, 1958.PubMedGoogle Scholar
  104. 104.
    Linde LM, Goldberg SJ, Seigel S. The natural history of arrhythmias following septal defect repair. J Thorac Cardiovasc Surg 48:303, 1964.PubMedGoogle Scholar
  105. 105.
    Greenwood RD, Rosenthal A, Sloss LJ, LaCorte M, Nadas AS. Sick sinus syndrome after surgery for congenital heart disease. Circulation 52:208, 1975.PubMedGoogle Scholar
  106. 106.
    Clark DS, Hirsch HD, Tamer DM, Gelband H. Electrocardiographic changes following surgical treatment of congenital cardiac malformations. Prog Cardiovasc Dis 17:451, 1975.PubMedGoogle Scholar
  107. 107.
    Brandenburg RO Jr, Holmes DR Jr, Brandenburg RO, McGoon DC. Clinical followup study of paroxysmal supraventricular tachyarrhythmias after operative repair of a secundum type septal defect in adults. Am J Cardiol 51:273, 1983.PubMedGoogle Scholar
  108. 108.
    Clark EB, Roland J, Varghese PJ, Neill CN, Haller JA Jr. Should the sinus venosus type ASD be closed? A review of atrial conduction defects and surgical results in 28 children. Am J Cardiol (Abstract) 35:127, 1975.Google Scholar
  109. 109.
    Rabinovitch M, Dick M, Bernhard W, Castaneda A. Incidence of postoperative arrhythmias in sinus venosus and secundum atrial septal defects. Pediatr Res (Abstract) 10:315, 1976.Google Scholar
  110. 110.
    Smith PK, Buhrman WC, Levett JM, Ferguson TB, Holman WL, Cox JL. Supravventricular conduction abnormalities following cardiac operations. J Thorac and Cardiovas Surg 85:105, 1983.Google Scholar
  111. 111.
    Williams RL. Use of transtelephonic electrocardiography in patients with symptoms suggesting cardiac arrhythmias. Pediatrics 61:493, 1978.PubMedGoogle Scholar
  112. 112.
    Dick M II, McFadden D, Crowley D, Rosenthal A: Diagnosis and management of cardiac rhythm disorders by transtelephonic electrocardiography in infants and children. J Pediatrics 94:612, 1979.Google Scholar
  113. 113.
    Hesslein PS. Noninvasive diagnosis of dysrhythmias. In PC Gillette, A Garson Jr (eds.), Pediatric Cardiac Dysrhythmias. New York: Grune & Stratton, 1981, p. 59.Google Scholar
  114. 114.
    Yabek SM, Akl BF, Berman W Jr, Neal JF, Dillon T. Bedside evaluation of postoperative sinus node function in children. Thorac and Cardiovasc Surg 81:691, 1981.Google Scholar
  115. 115.
    Cramer M, Hariman RJ, Boxer R, Hoffman BF. Electrograms from the canine sinoatrial pacemaker recorded in vitro and in situ. Am J Cardiol 42:939, 1978.PubMedGoogle Scholar
  116. 116.
    Krongrad E, Harriman RJ, Boxer RA, Weiss MB, Steeg CN, Hoffman BF. A method for recording of sinus node and ectopic atrial pacemaker electrograms during cardiac catheterization in humans. Circulation (Abstract) 58:II–146, 1978.Google Scholar
  117. 117.
    Mackintosh AF, English MJ, Vincent R, Woollons DJ, Chamberlain DA. Low voltage electrical activity preceding right atrial depolarisation in man. Br Heart J 42:117, 1979.PubMedGoogle Scholar
  118. 118.
    Hariman RJ, Krongrad E, Boxer RA, Weiss MB, Steeg CN, Hoffman BF. Method for recording electrical activity of the sinoatrial node and automatic atrial foci during cardiac catheterization in human subjects. Am J Cardiol 45:775, 1980.PubMedGoogle Scholar
  119. 119.
    Reiffel JA, Gang E, Gliklich J, Weiss MB, Davis JC, Patton JN, Bigger JT Jr. The human sinus node electrogram: A transvenous catheter technique and a comparison of directly measured and indirectly estimated sinoatrial conduction time in adults. Circulation 62:1324 1980.PubMedGoogle Scholar
  120. 120.
    Rakovec P, Jakopin J, Rode P, Kenda MF, Horvat M. Clinical comparison of indirectly and directly determined sinoatrial conduction time. Am Heart J 102:292, 1981.PubMedGoogle Scholar
  121. 121.
    Gomes JAC, Kang PS, El-Sherif N. The sinus node electrogram in patients with and without sick sinus syndrome: Techniques and correlation between directly measured and indirectly estimated sinoatrial conduction time. Circulation 66:864, 1982.PubMedGoogle Scholar
  122. 122.
    Yabek SM, Jarmakani JM, Roberts NK. Sinus node function in children: Factors influencing its evaluation. Circulation 53:28, 1976.PubMedGoogle Scholar
  123. 123.
    Kerr CR, Strauss HC. The nature of atriosinus conduction during rapid atrial pacing in the rabbit heart. Circulation 63:1149, 1981.PubMedGoogle Scholar
  124. 124.
    Gomes JA, Chowdhry I, Hariman R, El-Sherif N. New application of direct sinus node recording in man: Assessment of sinus node recovery time. J Am Coll Cardiol (Abstract) 1:635, 1983.Google Scholar
  125. 125.
    Strauss HC, Saroff AL, Bigger JT Jr, Giardina EGV. Premature atrial stimulation as a key to the understanding of sinoatrial conduction in man. Circulation 47:86, 1973.PubMedGoogle Scholar
  126. 126.
    Narula OS, Shantha N, Vasquez M, Towne WD, Linhart JW. A new method for measurement of sinoatrial conduction time. Circulation 58:706, 1978.PubMedGoogle Scholar
  127. 127.
    Breithardt G, Seipel L: Comparative study of two methods of estimating sinoatrial conduction time in man. Am J Cardiol 42:965, 1978.PubMedGoogle Scholar
  128. 128.
    Clapp SA, Driscoll DJ, Mitrani I, Lewis RM. Comparative effects of age and sedation on sinus node automaticity and AV node conduction. Dev Pharmacol Therap 2:180, 1981.Google Scholar
  129. 129.
    Jose AD, Collison D. The normal range and determinants of the intrinsic heart rate in man. Cardiovasc Res 4:160, 1970.PubMedGoogle Scholar
  130. 130.
    Jordan JL, Yamaguchi I, Mandel WJ. Studies on the mechanism of sinus node dysfunction in the sick sinus syndrome. Circulation 57:217, 1978.PubMedGoogle Scholar
  131. 131.
    Desai JM, Scheinman MM, Strauss HC, Massie B, O’Young J. Electrophysiologic effects of combined autonomic blockage in patients with sinus node disease. Circulation 63:953, 1981.PubMedGoogle Scholar
  132. 132.
    Hesslein PS, Williams WG, Rowe RD. Hemodynamic utility of “physiologic” pacing in children. Circulation (Abstract) 66:11–170, 1982.Google Scholar
  133. 133.
    Benditt DG, Kriett JM, Haugland JM, Crouse L, Scheinman MM. Effects of aminophylline on sinus and atrioventricular (AV) node function in young adults with vaso-vagal syncope. Circulation (Abstract) 64:IV–143, 1981.Google Scholar
  134. 134.
    Engel TR, Leddy C, Gonzalez AD, Meister SG, Frankl WS. Electrophysiologic effects of hydralazine on sinoatrial function in patients with sick sinus node syndrome. Am J Cardiol 41:763, 1978.PubMedGoogle Scholar
  135. 135.
    Weiss AT, Rod JL, Gotsman MS, Lewis BS. Hydralazine in the management of symptomatic sinus bradycardia. Eur J Cardiol 12:261, 1981.PubMedGoogle Scholar
  136. 136.
    Fleming WH, Sarafian LB, Kugler JD, Hofschire PJ, Clark EB. Changing indications for pacemakers in children. Ann Thorac Surg 31:329, 1981.PubMedGoogle Scholar
  137. 137.
    Kay R, Estioko M, Wiener I. Primary sick sinus syndrome as an indication for chronic pacemaker therapy in young adults: Incidence, clinical features, and long-term evaluation. Am Heart J 103:338, 1982.PubMedGoogle Scholar
  138. 138.
    Gillette PC. Treatment of sinus node dysfunction. In SM Yabek, PC Gillette, JD Kugler (eds.), The Sinus Node in Pediatrics. Churchill Livingstone, 1984, p. 133.Google Scholar
  139. 139.
    Stone JM, Bhakta RD, Lutgen J. Dual chamber sequential pacing management of sinus node dysfunction: Advantages over single-chamber pacing. Am Heart J 104:1319, 1982.PubMedGoogle Scholar
  140. 140.
    Kappenberger L, Gloor HO, Babotai I, Steinbrunn W, Turina M. Hemodynamic effects of atrial synchronization in acute and long-term ventricular pacing. PACE 5:639, 1982.PubMedGoogle Scholar
  141. 141.
    Alicandri C, Fouad FM, Tarazi RC, et al. Three cases of hypotension and syncope with ventricular pacing: Possible role of atrial reflexes. Am J Cardiol 42:137, 1978.PubMedGoogle Scholar
  142. 142.
    McGoon MD, Maloney JD, McGoon DC, Danielson GK. Long-term endocardial atrial pacing in children with postoperative bradycardia-tachycardia syndrome and limited ventricular access. Am J Cardiol 49:1750, 1982.PubMedGoogle Scholar
  143. 143.
    Furman S, Fisher JD. Endless loop tachycardia in an AV universal (DDD) pacemaker. PACE 5:486, 1982.PubMedGoogle Scholar
  144. 144.
    Dulk KD, Lindemans FW, Bar FW, Wellens HJJ. Pacemaker related tachycardias. PACE 5:476, 1982.Google Scholar
  145. 145.
    VanGelder LM, El Gamal, MIH. Magnet application, a cause of persistent arrhythmias in physiological pacemakers. Report of 2 cases. PACE 5:710, 1982.PubMedGoogle Scholar
  146. 146.
    Furman S, Cooper JA. Atrial fibrillation during A-V sequential pacing. PACE 5:133, 1982.PubMedGoogle Scholar
  147. 147.
    Ziegler RF. Electrocardiographs Studies in Normal Infants and Children. Springfield, IL: Charles C. Thomas, 1951.Google Scholar
  148. 148.
    Valimaki I. Tape recordings of the electrocardiogram in newborn infants. II. Long-term ECG tape recordings of newborn infants. Acta Paediat Scand (Suppl) 199:1, 1969.Google Scholar
  149. 149.
    Scott O, Williams GJ, Fiddler GI. Results of 24 hour ambulatory monitoring of electrocardiogram in 131 healthy boys aged 10 to 13 years. Br Heart J 44:304, 1980.PubMedGoogle Scholar
  150. 150.
    Southall DP, Richards J, Mitchell P, et al. Study of cardiac rhythm in healthy newborn infants. Br Heart J 43:14, 1980.PubMedGoogle Scholar
  151. 151.
    Southall DP, Johnston F, Shinebourne EA, et al. 24-hour electrocardiographic study of heart rate and rhythm patterns in population of healthy children. Br Heart J 45:281, 1981.PubMedGoogle Scholar

Copyright information

© Martinus Nijhoff Publishing 1987

Authors and Affiliations

  • John D. Kugler

There are no affiliations available

Personalised recommendations