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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

 Jin-Kyu Park  ;  Junbeom Park  ;  Jae-Sun Uhm  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
 CIRCULATION JOURNAL, Vol.79(10) : 2148-2156, 2015 
Journal Title
Issue Date
Aged ; Algorithms* ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/physiopathology ; Electrocardiography* ; Female ; Humans ; Male ; Middle Aged ; Sick Sinus Syndrome*/diagnosis ; Sick Sinus Syndrome*/physiopathology ; Sinoatrial Node/physiopathology*
Corrected sinus node recovery time ; P-wave amplitude ; Sick sinus syndrome ; Sinus node dysfunction ; Sympathetic stimuli
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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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