Sinoatrial block

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]

Synonyms and keywords:

Overview

The sinoatrial (SA) node represents the original pacemaker of the heart. It's formed of cells, sometimes called P cells, in a compact region at the junction of the high right atrium and the superior vena cava. The surrounding cells or Perinodal cells, sometimes called (T) cells, transmit the electrical impulse from the SA node to the right atrium. Each of these cell types has distinct expression profiles of ion channels and gap junctions. SA nodal dysfunction typically results from either abnormalities in signal generation by the P cells or abnormalities in conduction across the T cells. Sinoatrial nodal dysfunction includes pauses, arrest, exit block and ultimately sick sinus syndrome. Here we will discuss sinoatrial block.

Differentiating Sinoatrial block from other Diseases

Other types of types of SA nodal dysfunction include:

• Sinus pause or sinus arrest; this abnormality is an alteration in discharge by the SA pacemaker; as a result, the duration of the pause is variable and presents as a pause with no P waves on EKG.
• Sinus arrhythmia; small changes in the sinus cycle length. The formal definition of sinus arrhythmia is a variation in the P-P interval by 0.12 sec (120 msec) or more in the presence of normal P waves and the usual PR interval. This type is common in the young, usually related to variation with respirations and is not considered abnormal.
• Wandering atrial pacemaker; which represents three or more ectopic foci within the atrial myocardium that serve as the dominant pacemaker.
• Sick sinus syndrome

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