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Europace Advance Access originally published online on August 13, 2008
Europace 2008 10(10):1176-1181; doi:10.1093/europace/eun211
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Syncope

Consecutive administration of atropine and isoproterenol for the evaluation of asymptomatic sinus bradycardia

Spiridoula Vavetsi1,2,*, Nikolaos Nikolaou1,3, Konstantinos Tsarouhas2, Georgios Lymperopoulos2, Ioannis Kouzanidis2, Ioannis Kafantaris2, Athanasios Antonakopoulos2, Christina Tsitsimpikou4 and John Kandylas1

1 Cardiology Department, Thriasio General Hospital of Elefsina, G. Gennimatas Avenue, Elefsina, Athens, Greece; 2 General Hospital Melission A. Fleming, 14, 25th Martiou Street, Melissia, Athens, Greece; 3 General Hospital, Agia Olga, 3–5, Agias Olgas Street, Nea Ionia, Athens, Greece; 4 General State Chemical Laboratory, Department of Drugs and Narcotics, 16 Tsocha Street, Ampelokipi, Athens, Greece

Aims: Sinus node function is commonly evaluated by the atropine test. The isoproterenol test is less used. The aim of this study was to evaluate chronotropic reserve in patients with asymptomatic sinus bradycardia using the combined administration of atropine and isoproterenol.

Methods and results: A total of 100 patients were studied, 18–70 years old, with permanent, asymptomatic, sinus bradycardia and no detectable cardiac disease. The standard administration protocols for atropine and isoproterenol were used and successive heart rate recorded. Patients were stratified into three groups: Group A (control), showing normal response to atropine and isoproterenol; Group B, demonstrating abnormal response to atropine; Group C, with abnormal response to atropine and isoproterenol. No statistically significant difference was observed between Groups A and B (P = 0.11), whereas Group C differed statistically from both Groups A (P < 0.000001) and B (P = 0.000003) to a significant extent. By the end of the 3-year follow-up period, 47% of the Group C patients had undergone permanent pacemaker implantation (DDDR)—Kaplan–Maier survival curves predict only 35% survival without pacing—whereas none did so in Groups A and B.

Conclusions: In patients with deficient chronotropic response to atropine administration, isoproterenol tests could differentiate those with inadequate chronotropic reserves, possibly requiring preventive pacemaker implantations.

Key Words: Sick sinus syndrome, Atropine, Isoproterenol

* Corresponding author. Tel/fax: +30 21 0 7750373. E-mail address: rvav1962{at}yahoo.gr

Manuscript submitted 23 March 2008. Accepted after revision 25 July 2008.


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