Use of intravenous adenosine as a noninvasive diagnostic test for sick sinus syndrome☆,☆☆

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Abstract

Background Testing for sick sinus syndrome (SSS) requires invasive stimulation protocols for sinus node recovery time (SNRT) and corrected sinus node recovery time (CSNRT). Methods and Results We compared the CSNRT with the lengthening of the sinus cycle length (ADO:SCL) corrected to the basic cycle length (ADO:CSNRT) after administration of an intravenous bolus of adenosine (0.15 mg/kg) in 10 patients with clinical SSS (group 1) and 67 control patients (group 2). With 550 ms as an abnormal result for the ADO:CSNRT (and for the CSNRT) as an indicator of sinus node dysfunction, the ADO:CSNRT had a sensitivity of 80% and specificity of 97% for detection of SSS compared with sensitivity and specificity of 70% and 95% for invasive CSNRT. When combined, the 2 tests had a sensitivity of 100%. There was significant difference in the CSNRT between group 1 (1848 ± 1825 ms) and group 2 (355 ± 169 ms, P < .0001) and a significant difference in ADO:CSNRT between group 1 (1168 ± 1002 ms) and group 2 (272 ± 592 ms, P < .0001). Conclusions We conclude that the ADO:CSNRT is a sensitive and specific test for SSS that equals invasive testing and should be considered as an alternative to invasive testing in patients with suspected SSS. (Am Heart J 1999;137:435-8.)

Section snippets

Patients

We studied a prospectively assembled consecutive cohort of 77 patients referred to the Electrophysiology Laboratory for evaluation of cardiac arrhythmia or syncope or for pacemaker insertion. Ten patients (group 1) had clinical SSS and 67 were control subjects (group 2). Four of the group 1 patients had previous pacemaker implantation for SSS, 5 were receiving their first pacemaker implant, and 1 SSS was diagnosed in the electrophysiology laboratory. Group 2 included 5 patients undergoing

Patients

Table I details the clinical and electrophysiologic data in patients with SSS.

. Clinical and electrophysiologic characteristics of patients with SSS

PatientAge/sexOther cardiac diagnosisDrugsADO:CSNRTCSNRT
158/FemalePAFAmiodarone4340800
281/FemaleCADDigoxin, diltiazem, amiodarone33002480
370/FemaleAVRDigoxin, procainamide10403180
475/FemaleNoneNone5450220
560/FemaleVT-LV nlBB865810
667/MaleNoneNone4701790
767/MaleCAD, MIBB1160370
882/FemaleNoneNone6301155
965/MaleNoneNone310560
1088/MaleNoneNone920320

AVR ,

Discussion

This study complements a report suggesting that intravenous adenosine is a valuable adjunct in the diagnosis of SSS.4 When compared with the CSNRT (an invasive test) the ADO:CSNRT has very similar sensitivity, specificity, and predictive accuracy. As opposed to Resh et al,4 this study demonstrated that the cutoff for abnormal ADO:CSNRT may be similar to that for the CSNRT (>550 ms). Additionally, the adenosine infusion was able to identify patients with clinically relevant SSS that were missed

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☆

Reprint requests: James L. Vacek, MD, Mid America Cardiology Associates, 4321 Washington, Ste 4000, Kansas City, MO 64111.

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