Diagnosis of sick sinus syndrome with intravenous adenosine injection

Abstract

Background：The most widely utilized indexes of sinus node dysfunction are the sinus node recovery time (SNRT and the corrected sinus node recovery time (CSNRT, both of which generally require catheterization. Adenosine exhibits negative chronotropic effects on the sinoatrial node. The use/accuracy of the Nnon-invasive and reliable sinus node function test with intravenous adenosine was investigated. Methods and Results： The clinical value of rapid intravenous injection of adenosine for the assessment of sinus node dysfunction was examined in 14 patients with sick sinus syndrome (SSS and 31 controls. After prophylactic insertion of a temporary pacemaker in the right ventricle, overdrive suppression test was conducted according to the standard technique. CSNRT was first measured to evaluate the sinus node function, and then measured again, after administration of an intravenous bolus of adenosine (6 mg and 12 mg. Post-adenosine corrected sinus node recovery time (ADO：CSNRT was calculated by subtracting the basal sinus cycle length from the longest sinus cycle length. When it was assumed that an ADO：CSNRT reading of over 550 msec indicated sinus node dysfunction, intravenous injection of 6 mg of adenosine exhibited a sensitivity of 85% and a specificity of 100% for the detection of sick sinus syndrome, while 12 mg had a sensitivity of 100% and a specificity of 90%. There were significant differences in ADO：CSNRT between the patient and control groups (6 mg 1501±1081 msec vs 64±109 msec；12 mg 4005±2055 msec vs 216±315 msec, respectively. Conclusion： ADO：CSNRT was found to be a highly sensitive and specific index for the diagnosis of sick sinus syndrome, and should be considered as an alternative to invasive testing in patients with suspected sick sinus syndrome. ( ( ( (Korean Circulation J 2001;31(8 :788-793