The value of adenosine test in the diagnosis of sick sinus syndrome: susceptibility of sinus and atrioventricular node to adenosine in patients with sick sinus syndrome and unexplained syncope

Abstract

Aims: Patients (pts) with sick sinus syndrome (SSS) and unexplained syncope show increased susceptibility of sinus and atrioventricular node (AVN) to intravenous adenosine, respectively. Our aim is to assess the diagnostic value of adenosine test in pts with SSS, as well as to evaluate the response of AVN to adenosine either in pts with unexplained syncope or in pts with syncope and known SSS.

Methods and results: The effect of adenosine administration on the sinus and AVN was studied in a population consisted of 19 pts with clinical SSS (group SSS), 7 pts with syncope of unknown origin (group SUO), and 12 control subjects (group C). We calculated the maximum corrected sinus node recovery time (CSNRT), after overdrive pacing of the atrium at cycle lengths of 600, 500, and 400 ms and compared this value with the longest sinus pause, following adenosine administration corrected to the basic cycle length (ADSNRT). The longest R-R interval during atrioventricular block in response to adenosine injection (ADAVB) was also measured. Adenosine was given in a bolus dose of 0.15 mgr/kg through a femoral or large antecubital vein. There was a significant difference in the mean values of CSNRT among the three groups: group SSS (651 +/- 228 ms) > group SUO (284 +/- 100 ms) = group C (291 +/- 117 ms), F(2.35) = 19.078, P = 0.000. A significant difference was also found with ADSNRT: group SSS (5437 +/- 6863 ms) > group SUO (122 +/- 120 ms) = group C (801 +/- 1897 ms), F(2.35) = 4.513, P = 0.018. Using 525 ms as a cutoff value indicating sinus node dysfunction, CSNRT had a sensitivity of 74% and specificity of 100% for diagnosis of SSS while ADSNRT had 94% and 84%, respectively. Higher values of ADAVB in pts with SSS (10659 +/- 5872) and SUO (10026 +/- 7092) in comparison with controls (3615 +/- 5002) were measured, F(2.35) = 5.697, P = 0.007. No difference in the degree of ADAVB was found between the pts with SUO (10026 +/- 7092 ms) and syncope in the presence of SSS (12058 +/- 6787 ms), F(1.15) = 0.356, P = 0.56.

Conclusion: Adenosine test appears to be at least comparable with CSNRT in making the diagnosis of SSS and may be considered as an alternative non-invasive test for confirmation of suspected SSS. No difference in the susceptibility of AVN to adenosine between the pts with syncope in the presence of SSS and those with unexplained syncope was found, suggesting that adenosine test cannot be used to diagnose atrioventricular block as the cause of syncope.