Arrhythmias in the Normal Human Heart

  • P. Taggart
Part of the Handbook of Experimental Pharmacology book series (HEP, volume 89)


This chapter is concerned with arrhythmias occurring in the normal heart particularly in response to stress. Various aspects are considered including the incidence of arrhythmia in people with apparently normal hearts as determined by electrocardiographic (ECG) recordings at rest, during 24-h ambulatory monitoring and during exercise; evidence that emotion may induce arrhythmia in normal people; the relationship of the sympathetic and parasympathetic nervous system; and prognostic importance and clinical implications. Problems arise in view of the inevitable difficulties of defining the “normal”. Research interest has been largely directed towards the abnormal heart and there is a relative paucity of information on the “normal”. Some reliance therefore has to be placed on control groups which in a number of instances are lacking in detail. There is a wide variation in the literature in the degree to which normality has been established, ranging from angiographic evidence in a few, through non-invasive studies in some to merely the absence of symptoms in the majority. The asymptomatic subjects tend to span a wide age range and it is inevitable that a proportion with significant cardiac disease will have been included. This may be important in view of the fact that the number exhibiting arrhythmia is relatively small.


Ventricular Tachycardia Ectopic Beat Ventricular Premature Beat Ventricular Ectopy Ventricular Ectopic Beat 
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. Adams CW (1972) Exercise and the heart. Introduction. Am Cardiol 30: 713–715Google Scholar
  2. Arcieri GP (1945) The circulation of the blood; and Andrea Cesalpino of Arezzo. SF Vanni, New YorkGoogle Scholar
  3. Barrett BA, Peter CT, Swan JJC, Singh BN, Mandel WJ (1981) The frequency and prognostic significance of electrocardiographic abnormalities in clinically normal individuals. Prog Cardiovasc Dis 22: 299–319CrossRefGoogle Scholar
  4. Benedict RV, Evans JM (1952) Second degree heart block and Wenkebach phenomenon associated with anxiety. Am Heart J 43: 626–633CrossRefGoogle Scholar
  5. Blom GE (1951) Review of electrocardiographic changes in emotional states. J Nerv Ment Dis 113: 283–300PubMedGoogle Scholar
  6. Bodenheimer MM, Banka VS, Helfant RH (1977) Relation between the site of origin of ventricular premature complexes and the presence and severity of coronary artery disease. Am J. Cardiol 40: 865Google Scholar
  7. Bogdonoff M, Harlan W, Estes E, Kirshner N (1959) Changes in urinary catecholamine excretion accompanying carbohydrate and lipid responses to oral examination (Abstr.) Circulation 20: 674Google Scholar
  8. Bouhuys A, Poole J, Binhorsl RA (1966) Metabolic acidosis of exercise in healthy males. J Appl Physiol 21: 1040–1046PubMedGoogle Scholar
  9. Brodsky M, Denes P, Kanakis C, Rosen KM, Wu D (1977) Arrhythmias documented by 24-hour continuous electrocardiographic monitoring in 15 male medical students without apparent heart disease. Am J Cardiol 39: 390–395CrossRefGoogle Scholar
  10. Cannon WB (1942) “Voodoo” death. Am Anthropol 44:169–181Google Scholar
  11. Carruthers M, Taggart P (1973) Vagotonicity of violence: biochemical and cardiac responses to violent films and television programmes. Br Med J 3: 384–389CrossRefGoogle Scholar
  12. Chiang BN, Pearlman LV, Ostrander LD, Epstein FH (1969) Relationship of premature systoles to coronary heart disease and sudden death in the Tecumseh epidemiologic study. Ann Intern Med 70: 1159–1166Google Scholar
  13. Clarke JM, Hamer J, Shelton JR, Taylor S, Venning GR (1976) The rhythm of the nor-mal human heart. Lancet 2: 508–512Google Scholar
  14. Cox WV, Robertson HF (1936) Effect of stellate ganglionectomy on cardiac function of intact dogs and its effect on extent of myocardial infarction and on cardiac function following coronary artery occlusion. Am Heart J 12: 285–300CrossRefGoogle Scholar
  15. Dickinson DF, Scott O (1984) Ambulatory electrocardiographic monitoring in 100 healthy teenage boys. Br Heart J 51: 179–183CrossRefGoogle Scholar
  16. Ebert PA, Vanderbeek RB, Allgood RJ, Sabiston DC Jr (1970) Effect of chronic cardiac denervation on arrhythmias after coronary artery ligation. Cardiovasc Res 4: 141–147CrossRefGoogle Scholar
  17. Einthoven W (1906) Léléctrocardiogramme. Arch Intern Physiol 4: 132Google Scholar
  18. Elliot RS, Buell JC (1983) The role of the CNS in cardiovascular disorders. Hosp Pract 18: 189–199Google Scholar
  19. Engel GL (1971) Sudden and rapid death during psychological stress. Folklore or folk wisdom? Ann Intern Med 74: 771–782PubMedGoogle Scholar
  20. Faris JV, Jordan JW, McHenry PL, Morris SN (1976) Prevalence and reproducibility of exercise-induced ventricular arrhythmias during maximal exercise testing in normal men. Am J Cardiol 37: 617–621CrossRefGoogle Scholar
  21. Fleg JL, Lakatta EG (1984) Prevalence and prognosis of exercise-induced non-sustained ventricular tachycardia in apparently healthy volunteers. Am J Cardiol 54: 762–764CrossRefGoogle Scholar
  22. Gomer KO, Hogstedt C, Bodin L, Soderholm B (1966) Frequency of extrasystoles in healthy male employees. Br Heart J 55: 259–264CrossRefGoogle Scholar
  23. Graybiel A, McFarland RA, Gates DC, Webster FA (1944) Analysis of electrocardiograms obtained from 1000 young healthy aviators. Am Heart J 27: 524–549CrossRefGoogle Scholar
  24. Harris AS (1966) Mechanism and therapy of cardiac arrhythmias. In: Dreifus LS, Likoff W (eds) Genesis of ventricular tachycardia and fibrillation following coronary occlusion. New York, Grune and Stratton, pp 293–301Google Scholar
  25. Hinkle LE, Carver ST, Stevens M (1969) The frequency of asymptomatic disturbances of cardiac rhythm and conduction in middle-aged men. Am J Cardiol 24: 629–650CrossRefGoogle Scholar
  26. His RH, Lamb LE (1962) Electrocardiographic findings in 122043 individuals. Circulation 25: 947–961Google Scholar
  27. Horan MJ, Kennedy HL (1984) Ventricular ectopy. History, epidemiology and clinical implications. JAMA 251: 380–386Google Scholar
  28. Hyde IH, Scalapino W (1918) The influence of music upon electrocardiograms and blood pressure. Am J Physiol 14: 35–38Google Scholar
  29. Jelinek MV, Lown B (1974) Exercise stress testing for exposure of cardiac arrhythmia. Prog Cardiovasc Dis 16: 497–522CrossRefGoogle Scholar
  30. Johnson RH, Walton JL, Kerbs HA, Williamson DH (1969) Metabolic fuels during and after severe exercise in athletes and non-athletes. Lancet 2: 452–455Google Scholar
  31. Jones MT, Bridges PK, Leak D (1968) Relationship between the cardiovascular and sympathetic responses to the psychological stress of an examination. Clin Sci 35: 73–79Google Scholar
  32. Kennedy HL, Buckingham TA, Goldberg RA, Kennedy LJ, Sprague MK, Whitlock JA (1985) Long-term-follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med 312: 193–197PubMedCrossRefGoogle Scholar
  33. Kershbaum A, Bellet S, Dickstein ER, Feinberg LJ (1961) Effect of cigarette smoking and nicotine on serum free fatty acids: based on a study in the human subject and the experimental animal. Circ Res 9: 631–638PubMedGoogle Scholar
  34. Kostis JB, Juo PT, McCrone K, Moreyra AE, Aglitz NM, Gotzoyannis S, Natarajan N (1981) Premature ventricular complexes in the absence of identifiable heart disease. Circulation 63: 1351–1356CrossRefGoogle Scholar
  35. Kurien BA, Yates PA, Oliver MF (1971) The role of free fatty acids in the production of ventricular arrhythmia after acute coronary artery occlusion. Eur J Clin Invest 1: 225–241Google Scholar
  36. Lamb LE, His RH (1962) Influence of exercise on premature contractions. Am J Cardiol 9: 209–216CrossRefGoogle Scholar
  37. Landis C, Slight D (1929) Studies of emotional reactions; cardiac responses. J Gen Psychol 2: 413–420CrossRefGoogle Scholar
  38. Lepeschkin E, Marchet H, Schroeder G, Wagner R, Paula D, de Silva P, Raab W (1969) Effect of epinephrine and norepinephrine on the electrocardiogram of 100 normal subjects. Am J Cardiol 5: 594–603CrossRefGoogle Scholar
  39. Levi L (1964) The stress of everyday work as reflected in productiveness, subjective feelings and urinary output of adrenaline and noradrenaline under salaried and piece-work conditions. J Psychosom Res 8: 199–202PubMedCrossRefGoogle Scholar
  40. Levi L (1965) The urinary output of adrenaline and noradrenaline during pleasant and unpleasant emotional states. Psychosom Med 27: 80–85PubMedGoogle Scholar
  41. Levi L (1966) Physical and mental stress reactions during experimental conditions simulating combat. Forsvarsmedicin 2: 3–8Google Scholar
  42. Levi L (ed) (1971) Society, stress and disease. Oxford University Press, London Levy MN ( 1977 ) Parasympathetic control of the heart. In: Randall WC (ed) Neural regulation of the heart. Oxford University Press, New York, pp 95–129Google Scholar
  43. Linton RAF, Lim M, Wolff CB, Wilmhurst P, Band DM (1984) Arterial plasma potassium measured continuously during exercise in man. Clin Sci 67: 427–431Google Scholar
  44. Loftus TA, Gold H, Diethelm O (1945) Cardiac changes in presence of intense emotion. Am J Psychiatry 101: 697–698Google Scholar
  45. Lown B (1982) Mental stress, arrhythmias and sudden death. Am J Med 72: 177–180PubMedCrossRefGoogle Scholar
  46. Lown B, Verrier RL, Rabinowitz SH (1977) Neural and psychologic mechanisms and the problem of sudden cardiac death. Am J Cardiol 39: 890–902CrossRefGoogle Scholar
  47. Malliani A, Schwartz PJ, Zanchetti A (1980) Neural mechanism in life threatening arrhythmias. Am Heart J 100: 705–715CrossRefGoogle Scholar
  48. Manning GW, Ahuja SP, Gutierrez MR (1968) Electrocardiographic differentiation between ventricular ectopic beats from subjects who have normal and diseased hearts. Acta Cardiol (Brux) 23: 462Google Scholar
  49. Marcomichelakis J, Donaldson R, Green J, Joseph S, Kelly HB, Taggart P, Somer- ville W (1980) Exercise testing after beta-blockade: improved specificity and predictive value in detecting coronary heart disease. Br Heart J 43: 252–261CrossRefGoogle Scholar
  50. Maron BJ, Roberts WC, McAllister HA, Rosing DR, Epstein SE (1980) Sudden death in young athletes. Circulation 60: 218–229Google Scholar
  51. McHenry PL, Fish C, Jordan JW (1972) Cardiac arrhythmias during maximal treadmill exercise testing in clinically normal men. Am J Cardiol 29: 331–336CrossRefGoogle Scholar
  52. McHenry PL, Jordan JW, Kavalier M, Morris SN (1976) Comparative study of exercise induced ventricular arrhythmias in normal subjects and patients with documented coronary artery disease. Am J Cardiol 37: 609–616CrossRefGoogle Scholar
  53. Morganroth J, Dunkman WB, Horowitz LN, Josephson ME, Michelson EL, Pearl- man AS (1978) Limitations of routine long-term electrocardiographic monitoring to assess ventricular ectopic frequency. Circulation 58: 408Google Scholar
  54. Northcote RJ, Ballantyne D, MacFarlane (1983) Ambulatory electrocardiography in squash players. Br Heart J 50: 372–377Google Scholar
  55. Northcote RJ, Flannigan C, Ballantyne D (1986) Sudden death and vigorous exercise—a study of 60 deaths associated with squash. Br Heart J 55: 198–203CrossRefGoogle Scholar
  56. Page LB, Riker JW, Berberich FR (1969) Phaeochromocytoma with predominant epinephrine secretion. Am J Med 47: 648–652CrossRefGoogle Scholar
  57. Patkai P, Frankenhaeuser M, Rissler A, Bjorkvall C (1967) Catecholamine excretion, performance and subjective stress. Scand J Psychol 8: 113–122CrossRefGoogle Scholar
  58. Probiete PF, Kennedy HL, Caralis DG (1978) Detection of ventricular ectopy in patients with coronary heart disease and normal subjects by exercise testing and ambulatory electrocardiography. Chest 74: 402–407CrossRefGoogle Scholar
  59. Raftery EB, Cashman PMM (1976) Long term recording of the electrocardiogram in a normal population. Postgrad Med J [Suppl 17] 52: 32–37CrossRefGoogle Scholar
  60. Reich P (1985) Psychological predisposition to life threatening arrhythmias, Annu Rev Med 36: 397–405PubMedCrossRefGoogle Scholar
  61. Rose G, Baxter PJ, Reid DD, McCartney P (1978) Prevalence and prognosis of electrocardiographic findings in middle-aged men. Br Heart J 40: 636–643PubMedCrossRefGoogle Scholar
  62. Rosenbaum MB (1969) Classification of ventricular extrasystoles according to form. J Electrocardiogr 2: 289CrossRefGoogle Scholar
  63. Ruskin JN (1985) Ventricular extrasystoles in healthy subjects. Engl J Med 312: 238–239CrossRefGoogle Scholar
  64. Ruskin JN, McGovern B, Garen H, DiMarco JP, Kelly E (1983) Anti-arrhythmic drugs: a possible cause of out-of-hospital cardiac arrest. N Engl Med 309: 1302–1306CrossRefGoogle Scholar
  65. Sabotka PA, Mayer JH, Bauernfeind RA, Kanakis C, Rosen KM (1981) Arrhythmias documented by 24-hour continuous ambulatory electrocardiographic monitoring in young women without apparent heart disease. Am Heart J 101: 753–759CrossRefGoogle Scholar
  66. Sayer WJ, Moser M, Mattingly TW (1954) Phaeochromocytoma and abnormal electro-cardiograms. Am Heart J 48:42–53 Schaal SF, Wallis AG, Sealy WC (1969) Protective influence of cardiac denervationGoogle Scholar
  67. against arrhythmias of myocardial infarction. Cardiovasc Res 3:241–244 Scherf D, Schott A (1973) Extrasystoles and allied arrhythmias. 2nd edn. Year BookGoogle Scholar
  68. Medical Publishers, Chicago, p 2 Scott O, Williams GJ, Fiddler GI (1980) Results of 24-hour ambulatory monitoring of electrocardiogram in 131 healthy boys aged 10-13 years. Br Heart J 44: 304–308Google Scholar
  69. Southall DP, Richard J, Mitchell P, Brown DJ, Johnston PGB, Shinebourne EA (1980) Study of cardiac rhythm in healthy newborn infants. Br Heart J 43: 14–20CrossRefGoogle Scholar
  70. Southall DP, Johnston FG, Shinebourne EA, Johnston PGB (1981) 24-hour electro-cardiographic study of heart rate and rhythm patterns in population of healthy children. Br Heart 45: 281–291Google Scholar
  71. Taggart P, Gibbons D, Somerville W (1969) Some effects of motor car driving on the normal and abnormal heart. Br Med J 4: 130–134CrossRefGoogle Scholar
  72. Taggart P, Carruthers M, Parkinson P (1972) Cardiac responses to thermal physical and emotional stress. Br. Med J 3: 71–76Google Scholar
  73. Taggart P, Carruthers M, Somerville W (1973) Electrocardiograms, plasma catecholamines and lipids, and their modification by Oxprenolol when speaking before an audience. Lancet 2: 341–346Google Scholar
  74. Taggart P, Hedworth-Whitty RB, Carruthers M, Gordon PD (1976) Observations on the electrocardiogram and plasma catecholamines during dental procedures; the forgotten vagus. Br Med J 2: 787–789CrossRefGoogle Scholar
  75. Taggart P, Carruthers M, Joseph S, Kelly HB, Marcomichelakis J, Noble D, O’Neill G, Somerville W (1979) Electrocardiographic changes resembling myocardial is- chaemia in asymptomatic men with normal coronary arteriogram. Br Heart J 41: 214–225PubMedCrossRefGoogle Scholar
  76. Taggart P, Donaldson R, Green J, Joseph S, Kelly HB, Marcomichelakis J, Noble D, White J (1982) The inter-relationship of heart rate and autonomic activity in asymptomatic men with unobstructed coronary arteries: studies by atrial pacing, adrenaline infusion and autonomic blockade. Br Heart J 47: 19–25PubMedCrossRefGoogle Scholar
  77. Taggart P, Carruthers M, Somerville W (1983) Some effects of emotion on the normal and abnormal heart. In: Proctor Harvey W (ed) Recurrent problems in cardiology, vol 7, no 12. Year Book Medical Publishers, Chicago, pp 1–29Google Scholar
  78. Toff WD, Bennett G, Joy M (1986) Exercise-induced arrhythmia and conduction disturbance in an asymptomatic population (Abstr 2953 ). American Heart Association, World Congress of Cardiology, September, WashingtonGoogle Scholar
  79. Tolson WW, Mason JW, Sachar EJ, Hamburg DA, Handion JH, Fisherman JR (1965) Urinary catecholamine responses associated with hospital admission in normal human subjects. J Psychosom Res 8: 365–372CrossRefGoogle Scholar
  80. Vaughan Williams EM (1970) Classification of anti-arrhythmic drugs. In: Sandoe E, Flensted-Jensen, E, Olesen KH (eds) Symposium on cardiac arrhythmia. Astra, Södertälje, pp 449–472Google Scholar
  81. Vaughan Williams EM (1986) Ventricular hypertrophy—physiological mechanisms. J Cardiovasc Pharmacol [Suppl 3] 8: 512–516Google Scholar
  82. Velebit V, Podrid JP, Lown B, Cohen BH, Graboys TB (1982) Aggravation and provocation of ventricular arrhythmias by anti-arrhythmic drugs. Circulation 65: 886–894CrossRefGoogle Scholar
  83. Viitasalo MT, Carla R, Eisalo A (1982) Ambulatory electrocardiographic recording in endurance athletes. Br Heart 47: 213–220CrossRefGoogle Scholar
  84. Von Euler US (1964) Quantification of stress by catecholamine analysis. Clin Pharmacol Ther 5: 398 - 404Google Scholar
  85. Von Euler US, Lundberg U (1954) Effect of flying on the epinephrine excretion in Air Force personnel. J Appl Physiol 6: 551–555Google Scholar
  86. Wellens HJJ, Vermeulen A, Durrer D (1972) Ventricular fibrillation on arousal from sleep by auditory stimuli. Circulation 46: 661–665Google Scholar
  87. Wit AL, Hoffman BF, Rosen MR (1975) Electrophysiology and pharmacology of cardiac arrhythmias. IX. Cardiac electrophysiologic effects of beta-adrenergic receptor stimulation and blockade. Part A. Am Heart J 90: 521–533Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • P. Taggart

There are no affiliations available

Personalised recommendations