Dynamic behavior and autonomic regulation of ectopic atrial pacemakers

Heikki V. Huikuri, Aino Maija Poutiainen, Timo H. Mäkikallio, M. Juhani Koistinen, K. E.Juhani Airaksinen, Raul D. Mitrani, Robert J. Myerburg, Agustin Castellanos

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background - Heart rate (HR) variability reflects the neural regulation of normal pacemaker tissue, but the autonomic nervous regulation of abnormal atrial foci originating outside the sinus node has not been well characterized. We compared the HR variability of tachycardias originating from the ectopic foci and the sinus node. Methods and Results - R-R-interval variability was analyzed from 24-hour Holter recordings in 12 patients with incessant ectopic atrial tachycardia (average HR 107±14 bpm), 12 subjects with sinus tachycardia (average HR 106±9 bpm), and 24 age- and sex-matched subjects with normal sinus rhythm (average HR 72±8 bpm). Time- and frequency-domain HR variability measures, along with approximate entropy, short- and long-term correlation properties of R-R intervals (exponents α1 and α2), and power-law scaling (exponent β), were analyzed. Time- and frequency-domain measures of HR variability did not differ between subjects with ectopic and sinus tachycardia. Fractal scaling exponents and approximate entropy were similar in sinus tachycardia and normal sinus rhythm, but the short-term scaling exponent α1 was significantly lower in ectopic atrial tachycardia (0.71 ± 0.16) than in sinus tachycardia (1.16 ± 0.13; P<0.001) or normal sinus rhythm (1.19±0.11; P<0.001). Abrupt prolongations in R-R intervals due to exit blocks from the ectopic foci or instability in beat-to- beat R-R dynamics were the major reasons for altered short-term HR behavior during ectopic tachycardias. Conclusions - HR variability obtained by time- and frequency-domain methods does not differ between ectopic and sinus tachycardias, which suggests that abnormal atrial foci are under similar long-term autonomic regulation as normal pacemaker tissue. Short-term R-R- interval dynamics are altered toward more random behavior in ectopic tachycardia, which may result from a specific autonomic disturbance or an intrinsic abnormality of ectopic atrial pacemakers.

Original languageEnglish (US)
Pages (from-to)1416-1422
Number of pages7
Issue number13
StatePublished - Sep 28 1999


  • Arrhythmia
  • Heart rate
  • Intervals
  • Tachycardia

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine


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