An Analysis of the Effects of Acetylcholine on Conduction and Refractoriness in the Rabbit Sinus Node

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The effects of acetylcholine (ACh) on sinus node automaticity, atrio-sinus conduction, and refractoriness were studied in 41 isolated rabbit right atrial preparations. Average control rate was 126 beats/min, and ACh 5 × 10−8 M, 5 × 10−7 M, and 5 × 10−7 M significantly decreased heart rate by 7, 15, and 43%, respectively (P < 0.01, 0.001, and 0.001). Atrio-sinus conduction time at a pacing cycle length of 400 msec did not significantly change during exposure to ACh 5 x 10−8 and 5 × 10−7 M. However, the mean effective refractory period (ERP) of the sinus node, at a pacing cycle length of 400 msec, increased from 183 ± 16 msec to 210 ± 24 msec during exposure to ACh 5 x 10−7 M (P< 0.025). The change in ERP followed the change in action potential duration. In contrast to the lack of effect of ACh 5 x 10−7 M on atrio-sinus conduction time, ACh 5 x 10−6 M caused 2:1 atrio-sinus block in 8 of 10 experiments. The site of block was identified using multiple microelectrode impalements, and occurred between the perinodal fibers bordering on the edge of the sinus node and the pacemaker area in the sinus node proper. When the pacing cycle length was increased and 1:1 atrio-sinus conduction was present, conduction time did not significantly differ from control. At this longer pacing cycle length the mean ERP of the sinus node was 380 msec greater than control and lasted well after repolarization was completed. Thus, atrio-sinus block during exposure to ACh 5 x 10−6 M resulted from a marked prolongation of refractoriness. Circ Res 44: 112-120, 1979

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