Localization of the duodenal pacemaker and its role in the organization of duodenal myoelectric activity.

In two series of conscious healthy dogs, a study of duodenal electric activity was made to locate the pacemaker or site of the greatest intrinsic frequency of the pacesetter potential. In three dogs, an annular myotomy of the duodenum about 1 cm proximal (orad) to the biliary ampulla caused a reduction in the frequency of the pacesetter potential distal (caudad) to the conduction block and demonstrated that the pacemaker was not in the region of the ampulla, as had been suggested previously. Annular myotomy of the duodenum at increasing intervals distal to the pylorus in a second series of eight dogs showed that the pacemaker was present in the proximal 5 to 6 mm of duodenum. The greater frequency of the pacemaker was found to maintain constant distal conduction of the pacesetter potential. Distal conduction of the pacesetter potential was shown on occasion to be associated with the distal propagation of action potentials along the duodenum.