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Autonomic nervous system in relation to age in patients with and without sinus node disease

par De Marneffe, Michel ;Grégoire, Jean-Marie ;Waterschoot, Patrick ;Kestemont, Marie-Paule
Référence European journal of cardiac pacing and electrophysiology, 2, 1, page (44-52)
Publication Publié, 1992

Article révisé par les pairs

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Résumé :

To determine the evolution, with age, of the autonomic nervous system in patients with and without sick sinus syndrome, electrophysiological studies of sinus node function were performed in 227 patients subdivided into 4 groups according to the results of their electrophysiological tests: Group (GR) 1 included patients with normal sinus node function in the basal state and after autonomic blockade; GR 2 patients with sinus node function exclusively abnormal in the basal state; GR 3 patients with sinus node function exclusively abnormal after autonomic blockade and GR 4 patients with sinus node dysfunction in the basal state and after autonomic blockade. The electrophysiological study was performed twice: in the basal state, under physiological conditions (B) and after autonomic blockade (AB). The autonomic ratios (AB-B) over B relative to the increase in each sinus node electrophysiological parameter with increasing age (in all groups) suggested a predominance of parasympathetic tone in the younger patients and a preeminence of sympathetic activity in the elderly. The autonomic ratio for heart rate increased, with increasing age, similarly in patients with and without sick sinus syndrome. Concerning the sinus node automaticity and sinoatrial conduction, the age-related changes of the autonomic nervous system (increase of sympathetic tone and/or decrease of parasympathetic activity with increasing age, are especially pronounced when GR 2 is compared with GR 1 and GR 4 is compared with GR 3. This evolution, with age, of the autonomic nervous system counterbalances the senescence of the sinus node intrinsic function when isolated from autonomic influence. This alteration of balance of the parasympathetic and the sympathetic occurs at an earlier in patients with intrinsic sinus node dysfunction and later in patients with sinus dysfunction related to autonomic disturbance.