Abstract 11482: Combined Algorithm Using a Poor Increase in Inferior P-Wave Amplitude During Sympathetic Stimulation and Conventional CSNRT as a Diagnostic Method for Sick Sinus Syndrome
Introduction: Sick sinus syndrome (SSS) is mainly diagnosed based on clinical criteria and there is still no non-invasive study to assess the degree of sinoatrial node (SAN) dysfunction.
Hypothesis: This study sought to evaluate whether a combined algorithm using a poor increase in inferior P-wave amplitude during sympathetic stimulation and conventional CSNRT might be a helpful diagnostic tool for SSS.
Methods: Three dimensional endocardial mapping of right atrium (RA), P-wave amplitude of inferior axis and corrected sinus node recovery time (CSNRT) were compared in consecutive 105 atrial fibrillation patients with (n=18) and without SSS (n=87).
Results: The distances from the superior vena cava (SVC) to the RA early activation site (EAS) were negatively correlated with P-wave amplitude of lead II (r=-0.41, p<0.001), III (r=-0.41, p<0.001) and aVF (r=-0.43, p<0.001). The significant cranial shift of EAS (the distance from SVC to EAS: 11.0 vs. 6.1 mm, p<0.001), and the increase of P-wave amplitude of lead II, III and aVF during isoproterenol infusion (all p<0.001) were observed in patients without SSS. However, cranial shift of EAS (22.5 vs. 12.5 mm, p=0.265) and P-wave amplitude increases were not observed in those with SSS. While the CSNRT of > 550 ms showed a sensitivity of 50% and specificity of 87% for diagnosing SSS, poor increases of P-waves amplitude of lead aVF (< 0.1 mV) during isoproterenol infusion showed an improved sensitivity of 78% and specificity of 89%. Finally, the combined algorithm using CSNRT of > 550 ms and poor increases of P-waves amplitude of lead aVF showed more improved diagnostic accuracy (the sensitivity of 89% and specificity of 76%).
Conclusion: Significant increases in inferior P-wave amplitudes during isoproterenol infusion were impaired in AF patients with SSS. The combined algorithm using the poor increase in inferior leads and CSNRT of > 550 ms showed improved performance for the diagnosis of SSS compared to CSNRT of > 550 ms alone.
Author Disclosures: J. Park: None. J. Park: None. H. Mun: None. J. Uhm: None. H. Pak: None. M. Lee: None. B. Joung: None.
- © 2014 by American Heart Association, Inc.