Original communication| Volume 26, ISSUE 5, P727-744, November 1949

The human heart rate

Some observations and deductions based upon the effect of removing portions of the sympathetic nervous system in man
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      Evidence is presented which suggests that the cardioaccelerator fibers in man arise from the second to the fifth thoracic segments of the cord inclusive and bilaterally.
      The outflow from the right side appears to be slightly more important than from the left.
      The effect of unilateral cardiac denervation, right or left, upon heart rate is slight by comparison with the effect of bilateral denervation.
      Following complete sympathetic motor denervation, the resting pulse rates are slower in all groups, particularly in those having more rapid rates originally. The final rates are faster in the original faster basal rate groups suggesting that tachycardia (resting) is due to a combination of increased sympathetic and decreased vagus tone.
      In response to exercise, the percentage increase in maximal heart rate is greater before than after operation, particularly in the slower rate groups. After operation the accelerator response is the same in both groups. This suggests that stimulation of cardioaccelerator fibers is superimposed upon inhibition of vagus tone in causing increased heart rate in response to exercise in the normally innervated state. Following sympathectomy, cardiac acceleration appears to be the result of inhibition of vagus tone.
      Resection of the cardioaccelerator fibers in man has been helpful in the management of hypertensive patients having unusual degrees of tachycardia. It has also been helpful in a small group of patients having exertional or emotional tachycardia.
      It would appear that cardiac denervation may be an effective procedure in certain cases of paroxysmal auricular tachycardia.
      No untoward effects have followed resection of the cardioaccelerator fibers in man, in our experience.
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