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Combined Algorithm Using a Poor Increase in Inferior P-Wave Amplitude During Sympathetic Stimulation and Sinus Node Recovery Time for the Diagnosis of Sick Sinus Syndrome

Authors
 Jin-Kyu Park  ;  Junbeom Park  ;  Jae-Sun Uhm  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
Citation
 Circulation Journal, Vol.79(10) : 2148-2156, 2015 
Journal Title
 Circulation Journal 
ISSN
 1346-9843 
Issue Date
2015
Abstract
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.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/141314
DOI
10.1253/circj.CJ-15-0561
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
박희남(Pak, Hui Nam) ; 엄재선(Uhm, Jae Sun) ; 이문형(Lee, Moon Hyoung) ; 정보영(Joung, Bo Young)
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