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European Heart Journal 1984 5(11):890-895;
Copyright © 1984 by the European Society of Cardiology.
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© 1984 The European Society of Cardiology

Alternating sinus rhythm and intermittent sinoatrial block induced by propranolol

M. ÖZTÜRK and C. DEMIROG{caron}LU

The Cardiology Institute, Istanbul University Istanbul, Turkey

Received 22 June 1984; .

Address for Correspondence: Dr Muzaffer Özlürk, Istanbul Üniversitesi, Kardiyoioji Enstitüsü, Haseki, Istanbul, Turkey.

Abstract

Alternating sinus rhythm and intermittent sinoarrial (S-A) block was observed in a 57-year-old woman, under treatment for angina with 80 mg propranolol daily.

The electrocardiogram showed alternation of long and short P-P intervals and occasional pauses. These pauses were always preceded by the short P-P interval and were usually followed by one or two P-P intervals of 0.92–0.95 s representing the basic sinus cycle. Following these basic sinus cycles, alternating rhythm started with the longer P-P interval. The long P-P intervals ranged between 1.04–1.12s and the short P-P intervals between 0.80–0.84 s, respectively. The duration of the pauses were equal or almost equal to one short plus one long P-P interval or to twice the basic sinus cycle. In one recording a short period of regular sinus rhythm with intermittent 2/1 S-A block was observed. This short period of sinus rhythm was interrupted by sudden prolongation of the P-P inlerval starting the alternating rhythm.

There were small changes in the shape of the P waves and P-R intervals.

S-A conduction through two pathways, the first with 2/1 block the second having 0.12–0.14 s longer conduction time and with occasional 2/1 block was proposed for the explanation of the alternating P-P interval and other electrocardiographic features seen.

Atropine I mg given intravenously resulted in shortening of all P-P intervals without changing the rhythm.

The abnormal rhythm disappeared with the withdrawal of propranolol and when the drug wvas restarted a 2/1 S-A block was seen. This was accepted as evidence for propranolol being the cause of this conduction disorder.

Key Words: Alternating sinus rhythm • sinoatrial block • alternating sinoatrial pathways • propranolol


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