Does overdrive suppression by right atrial pacing evaluate sino-atrial node function and identify sick sinus syndrome in patients?
Measuring the pause duration after cessation of rapid atrial pacing (overdrive suppression) provides a technique for identifying abnormalities in sino-atrial node function, such as sick sinus syndrome.
Sino-atrial node (SAN) function was evaluated in 46 patients, three of whom had the sick sinus syndrome. Patients were paced from the right atrium for 15 to 180 sec at rates of 90, 110, 130, and 150 beats/min. The rapid cessation of pacing was associated with suppression of the SAN at all paced rates and at all durations of pacing. The observed pause was terminated by a sinus beat in all instances. The duration of pacing had little influence on the duration of the observed pause. The pause increased as the pacing rate was increased until, at a rate of 150 beats/min, a marked decrease in the pause was noted. Atropine (1.5-3.0 mg iv) diminished but did not eliminate the SAN suppression. Subthreshold pacing did not suppress SAN function. Three patients with sick sinus syndrome had a greater degree of SAN suppression than normal patients (4732 ± 415 msec SSS M ± sem ; 1041 ± 56 msec for normal patients). The determination of the duration of the pause following cessation of atrial pacing provides a technique for recognition of abnormalities of SAN function.
Mandel et al. (1971) studied this question.