[The influence of frequency and blockade of the autonomic nervous system on the functional behaviour of the human conduction system. Part B: Refractory periods (author's transl)]

Abstract

32 patients were studied by His-bundle-electrocardiogram and programmed atrial stimulation to examine to which extent frequency and autonomic tone participate in influencing the effective (ERP) and functional (FRP) refractory periods of the atrium and AV-node. The measurements were performed during three electrically induced atrial frequencies before and after intravenous injection of 1 mg Atropine (15 patients) and 0.4 mg Visken (17 patients). For the atrium, frequency dominates the blockade of both components of the autonomic nervous system in influencing both refractory periods. Increase in frequency shortens both ERP and FRP of the atriu. The blockade of parasympathicus and sympathicus does not significantly influence the changes in atrial ERP and FRP induced by atrial pacing. The AV-node responses most sensitive to both pacing induced cycle length shortening and blockade of the autonomic tone. Cycle length shortening prolongs the nodal ERP. the FRP is either shortened or prolonged. Blockade of the parasympathicus shortens both nodal ERP and FRP. Blockade of the sympathicus lengthens both parameters. This behaviour of both refractory periods in response to atrial pacing and blockade of the autonomic tone are discussed with respect to the "gate mechanism" in the conduction system. In the majority of patients blockade of the parasympathicus shifts the "gate" from the AV-node to the atrium. Blockade of the sympathicus has the opposite effect in some cases.