Short‐Term Rapid Atrial Pacing Produces Electrical Remodeling of Sinus Node Function in Humans

Abstract

Rapid atrial pacing for only 10 to 15 minutes, simulating transient atrial tachyarrhythmias, alters sinus node function in humans. Additional studies are needed to evaluate the mechanism, but the clinical implication is that even transient episodes of atrial tachyarrhythmias can cause sinus node remodeling in patients.

Heart rate turbulence after atrial premature beats before spontaneous onset of atrial fibrillation

“…One plausible mechanism is the sinus node resetting, which has been described to occur in response to atrial premature complexes (38). However, TO was not related to the prematurity of atrial impulses, suggesting that the changes in the resetting of sinus activity may not be the predominant factor influencing the temporal changes of TO.…”

Sinus node revisited

“…In patients following cardioversion of chronic atrial fibrillation, prolonged sinus node recovery time was noted as compared with controls [39]. Likewise, short-term rapid atrial pacing has been shown to result in sinus node remodeling with significantly increased sino-atrial conduction time and sinus node recovery time [40]. The work by Stiles et al…”

“…Evidence of sinus node remodeling has been identified in aging and common conditions such as heart failure and atrial arrhythmias [5 , [37][38][39][40]. Kistler and co-workers [37] demonstrated prolonged sinus node recovery time with anatomically determined conduction delay at the crista terminalis in patients greater than 60 years of age as compared to younger control patients under 30 years of age.…”

“…While it has been recognized that the atrial myopathy in SND can result in increased atrial fibrillation, there is also evidence that atrial arrhythmias can result in sinus node remodeling [5 , 39,40]. In patients following cardioversion of chronic atrial fibrillation, prolonged sinus node recovery time was noted as compared with controls [39].…”

Giant P waves after pharmacological cardioversion of atrial fibrillation

“…Analogously, the possibility that the giant P wave reflected atrial stunning, a mechanical dysfunction that has been described following both electrical and pharmacological cardioversion, [8,9], conflicts with post-cardioversion echocardiography. However, even a brief period of high atrial frequency can induce an electrical remodeling [10], both of sinus node and of atrial electrophysiologic substrate [11,12], without an evident atrial mechanic dysfunction. In fact temporal patterns of progression and regression of electrical and mechanic remodeling of the atrium are different [13].…”