Subthreshold bipolar atrial stimulation affects the discharge rate of the sinus node: an animal study

Aim of this study was to verify whether the electrical field generated inside the right atrium by sub-threshold electrical impulses (impulses unable to induce cells activation) may condition the discharge rate of the sinus node cells. An electrophysiological study was performed on seven young farm pigs before and after denervation. After general anesthesia, pigs were stimulated with impulses delivered at constant rate by a bipolar catheter positioned inside the right atrium. The amplitude of the stimulus was set to avoid atrial capture. A 10-minute atrial stimulation was performed at a rate above and below the spontaneous heart rate, both before and after denervation. Three animals showed a conditioning of the sinus rhythm, observed as phase synchronization. The different response, or even the no response, of animals to stimulation could be due to different factors, concerning biological, pharmacological and "geometric" conditions. The important result remains that a perturbation of the sinus rhythm can be induced by a very low electrical field, as the one generated by the activity of artificial pacemakers, and it could help explaining the onset of rhythm disturbances in paced patients.