Observations of the effect of arrhythmias on the cerebral function by recordings of 24-hour continuous electrocardiograms. Comparison between the sick sinus syndrome and atrio-ventricular block.

The influence of arrhythmias on cerebral function was investigated in 8 patients with sick sinus syndrome (bradycardia tachycardia syndrome) and 8 patients with advanced or complete atrioventricular block using 24-hour continuous recordings of the electrocardiogram and conventional electroencephalogram recordings. Syncope was observed more frequently in the atrio-ventricular block group, and was observed frequently when the longest heart beat pause during a 24-hour day was longer than 2.2 sec. Cerebral infarction as a complication of these arrhythmias was observed only with the sick sinus syndrome group. The maximum heart rate during a 24-hour day and the difference between maximum and minimum heart rate were significantly lower in the atrioventricular block group than in the sick sinus syndrome group. The electroencephalogram results showed a slight slowing of the background activity and the appearance of slow wave bursts in both groups. These abnormal findings were improved during intracardiac pacing in the atrio-ventricular block group. A quantitative analysis of the frequency of the electroencephalogram at various heart rates demonstrated the optimum pacing rate for the cerebral function. These results suggest that both the cerebral function and the cardiac function must be considered in the treatment of patients with bradycardia arrhythmias.