Key result
A combined algorithm using corrected sinus node recovery time >550 ms and poor increase in inferior P-wave amplitude during sympathetic stimulation improved sensitivity for diagnosing sick sinus syndrome to 89% compared to 50% with CSNRT alone.
Why the study?
Does a combined algorithm using inferior P-wave amplitude during sympathetic stimulation and corrected sinus node recovery time improve the diagnosis of sick sinus syndrome in patients with atrial fibrillation?
Observational (n=112)
Blinded assessors
No
Does a combined algorithm using inferior P-wave amplitude during sympathetic stimulation and corrected sinus node recovery time improve the diagnosis of sick sinus syndrome in patients with atrial fibrillation?
Absolute Event Rate: 89% vs 50%
A combined diagnostic algorithm using inferior P-wave amplitude during isoproterenol infusion and corrected sinus node recovery time improves the detection of sick sinus syndrome in patients with atrial fibrillation.
May aid sick sinus syndrome diagnosis in AF; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: This study sought to evaluate whether a poor increase in inferior P-wave amplitude during sympathetic stimulation might be a helpful diagnostic tool for sick sinus syndrome (SSS). METHODS AND RESULTS: Three-dimensional electroanatomic mapping of the right atrium, inferior P-wave amplitude and conventional corrected sinus node recovery time (CSNRT) were compared in 112 consecutive atrial fibrillation (AF) patients with (n=21) and without SSS (n=91). The significant cranial shift of earliest activation site (EAS) (the distance from the superior vena cava to the EAS: 11.1 vs. 5.9 mm, P<0.001) and the increases of inferior P-wave amplitudes during isoproterenol infusion (all P<0.001) were observed in patients without SSS. However, cranial shift of EAS (16.5 vs. 14.2 mm, P=0.375) and P-wave amplitude increases were not observed in those with SSS. Although CSNRT >550 ms showed a sensitivity of 50% and specificity of 84% for diagnosing SSS, poor increases of P-waves amplitude in lead aVF (<0.1 mV) during isoproterenol infusion showed an improved sensitivity of 71% and specificity of 89%. Finally, the combined algorithm using CSNRT >550 ms and poor increase of P-waves amplitude in lead aVF showed more improved diagnostic accuracy (sensitivity 89%, specificity 75%). CONCLUSIONS: A combined algorithm using inferior P-wave amplitude showed improved performance for the diagnosis of SSS compared with CSNRT >550 ms alone.
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Park et al. (2015) conducted an observational in Atrial Fibrillation and Sick Sinus Syndrome (n=112). Combined diagnostic algorithm (CSNRT >550 ms and aVF P-wave amplitude <0.1 mV during isoproterenol) vs. CSNRT >550 ms alone was evaluated on Sensitivity for diagnosing Sick Sinus Syndrome. A combined algorithm using corrected sinus node recovery time >550 ms and poor increase in inferior P-wave amplitude during sympathetic stimulation improved sensitivity for diagnosing sick sinus syndrome to 89% compared to 50% with CSNRT alone.
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