Autonomic transmitter actions on cardiac pacemaker tissue: a brief review.

Application of the voltage clamp technique to cardiac primary pacemaker tissue has yielded sufficiently detailed information that a qualitative model of the pacemaker response can now be formulated. One important difference between the generation of spontaneous activity in sinus tissue, and in the Purkinje fiber, appears to be the involvement of the slow inward current, Isi, in the sinus pacemaker depolarization. The voltage clamp results also demonstrate the importance of the Isi in the chronotropic responses of pacemaker tissue. Epinephrine has been shown to increase Isi in rabbit sinoatrial node, and there is indirect evidence that acetylcholine may reduce Isi in reptilian sinus venosus. Additional, more quantitative data are essential, however, before cardiac primary pacemaker activity and its modulation by the autonomic transmitters can be fully understood.