• S Polic, J L Atlee, A Laszlo, J P Kampine, and Z J Bosnjak.
• Department of Anesthesiology, Medical College of Wisconsin, Milwaukee 53226.
• Anesthesiology. 1991 Aug 1; 75 (2): 298-304.

AbstractKnowledge of anesthetic effects on the automaticity of dominant and subsidiary cardiac pacemakers is fundamental to an understanding of mechanisms of arrhythmia during anesthesia, as well as to the management of patients with sinus node dysfunction or atrioventricular (AV) conduction block. Among potential pacemakers of the heart are subsidiary atrial pacemakers (SAP), which are located outside the classic sinoatrial (SA) node region but still within the right atrium. SAP have a higher inherent rate of automaticity than AV junctional pacemakers, may contribute to a multicentric atrial pacemaker complex, and can control the rhythm of the heart when the SA node is absent or inhibited. How halothane, epinephrine (E), or norepinephrine (NE), alone or in combination, would affect the relation between the automaticity of the SA node and SAP was tested using an isolated, perfused canine right atrial preparation (n = 78). This preparation was perfused via the SA node artery with Krebs' solution (36.0 +/- 0.5 degrees C) equilibrated with 97% oxygen-3% carbon dioxide. Delivered concentrations of halothane of 1 or 2% corresponded to measured perfusate concentrations of 0.50 +/- 0.02 or 0.80 +/- 0.04 mM in experiments with E (n = 24) and 0.45 +/- 0.02 or 0.75 +/- 0.04 mM in experiments with NE (n = 54). E or NE perfusate concentrations were 1, 2, and 5 micrograms/l or 2, 5, and 10 micrograms/l, respectively. To determine the site of earliest activation (SEA), extracellular recordings were made from the SA node region and distal sites (approximately 1, 2, and 3 cm) along the sulcus terminalis, the previously reported locations of SAP.(ABSTRACT TRUNCATED AT 250 WORDS)

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