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

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)2148-2156
Number of pages9
JournalCirculation Journal
Volume79
Issue number10
DOIs
Publication statusPublished - 2015 Sep 25

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Sick Sinus Syndrome
Sinoatrial Node
Sensitivity and Specificity
Superior Vena Cava
Heart Atria
Atrial Fibrillation
Lead

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "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",
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.",
author = "Park, {Jin Kyu} and Junbeom Park and Uhm, {Jae Sun} and Pak, {Hui Nam} and Lee, {Moon Hyoung} and Boyoung Joung",
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doi = "10.1253/circj.CJ-15-0561",
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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. / Park, Jin Kyu; Park, Junbeom; Uhm, Jae Sun; Pak, Hui Nam; Lee, Moon Hyoung; Joung, Boyoung.

In: Circulation Journal, Vol. 79, No. 10, 25.09.2015, p. 2148-2156.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 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

AU - Park, Jin Kyu

AU - Park, Junbeom

AU - Uhm, Jae Sun

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Joung, Boyoung

PY - 2015/9/25

Y1 - 2015/9/25

N2 - 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.

AB - 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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U2 - 10.1253/circj.CJ-15-0561

DO - 10.1253/circj.CJ-15-0561

M3 - Article

C2 - 26289967

AN - SCOPUS:84942549044

VL - 79

SP - 2148

EP - 2156

JO - Circulation Journal

JF - Circulation Journal

SN - 1346-9843

IS - 10

ER -