© 2000 by European Society of Cardiology
Sinus node recovery time assessment by the overdrive suppression test employing an intravenous injection of disopyramide phosphate
Second Department of Internal Medicine, Yokohama City University Urafune Hospital Yokohama, Japan
Although sinus node recovery time (SNRT) assessment by the overdrive suppression test (ODST) is important in detecting sick sinus syndrome (SSS), its sensitivity is still inadequate. We have evaluated the effect of intravenous injection (i.v.) of disopyramide phosphate (DP) in ODST. The subjects were 30 SSS patients (64·9±10·0 <SD> years old). If SNRT was <2000 ms or the corrected SNRT (CSNRT) was <1000 ms, ODST was repeated after DP i.v. (2 mg . kg–1, 
100 mg in total). Eleven normal subjects (59·3±9·0 years old) were also studied. Although SNRT was <2000 ms or the CSNRT was <1000 ms in 13 of the 30 SSS patients (43%), SNRT was prolonged from 1510±300 ms to 3400±1160 ms (P<0·01), and CSNRT from 510±190 to 2470±1470 ms (P<0·01) after DP i.v. in these patients. Thus, SNRT was 
2000 ms and the CSNRT was 1000 ms in 27 of 30 SSS patients (90%) after DP i.v. Using a combination of overdrive suppression and intravenous injection of disopyramide phosphate, the corrected sinus node recovery time was diagnostic (>525 ms) in 29 of the 30 patients (97%). In contrast, SNRT and CSNRT were shortened in the normal subjects during ODST after DP i.v. (P<0·01). The plasma concentration of DP estimated in nine patients was 4·1±1·0 µg . ml–1. No serious side effect occurred. ODST employing DP i.v. is safe and seems to be highly effective in diagnosing SSS.
Key Words: Overdrive suppression test, sinus node recovery time, sick sinus syndrome, disopyramide
Correspondence: Toshiyuki Ishikawa, MD, Second Department of Internal Medicine, Yokohama City University Urafune Hospital, 3–46, Urafune-cho, Minami-ku, Yokohama 232–0024, Japan.
[1] Mandel W, Hayakawa H, Danzig R. Evaluation of sino-atrial node function in man by overdrive suppression. Circulation 1971; 44: 59–66.
[2] Narula OS, Samet P, Javier RP. Significance of the sinus-node recovery time. Circulation 1972; 45: 140–158.
[3] Mandel W, Hayakawa H, Allen HN. Assessment of sinus node function in patients with sick sinus syndrome. Circulation 1972; 46: 761–769.
[4] Jordan JL, Yamaguchi I, Mandel WJ. Studies on mechanism of sinus node dysfunction in the sick sinus syndrome. Circulation 1978; 57: 217–223.
[5] Gann D, Tolentino A, Samet P. Electrophysiologic evaluation of elderly patients with sinus bradycardia. A long-term follow-up study. Ann Intern Med 1979; 90: 24–29.
[6] Medvedowsky JL, Barnay C, Arnaud C, Vinevey JC. Etude electrophysiologique du dysfonctionment sinusal. Arch Mal Coeur 1978; 71: 49–59.
[7] Benditt DG, Gornick CC, Dunbar D. Indication for electrophysiologic testing in the diagnosis and assessment of sinus node dysfunction. Circulation 1987; 75: 93–99.
[8] Zipes DP, Denes P, Garson A Jr. Guidelines for clinical intracardiac electrophysiologic studies. Circulation 1989; 80: 1925–1935.
[9] Spurrell RAJ, Thorburn CW, Camm J. Effects of disopyramide on electrophysiological properties of the specialized conduction system in man and accessory atrioventricular pathways in Wolff-Parkinson-White syndrome. Br Heart J 1975; 37: 861–867.
[10] Seipel L and Breithardt G. Sinus recovery time after disopyramide phosphate. Am J Cardiol 1976; 37: 1118.[Medline]
[11] An LeBarre BA, Strauss HC, Scheinman MM. Electrophysiologic effects of disopyramide phosphate on sinus node function in patients with sinus node dysfunction. Circulation 1979; 59: 226–235.
[12] Usui T, Kashiwagi M, Kikuta M. Clinical study of sick sinus syndrome — The effects of disopyramide phosphate. Jap Circ J 1981; 45: 909.
[13] Rosen KM, Loeb HS, Sinno MZ. Cardiac conduction in patients with symptomatic sinus node disease. Circulation 1971; 43: 836–844.
[14] Josephson M. Clinical cardiac electrophysiology. Techniques and interpretations 1993; 2nd edn Philadelphia Lea & Febiger.
[15] Kulbertus HE, de Lavel-Rutten F, Casters L. Sinus node recovery time in elderly. Br Heart J 1975; 37: 420–425.
[16] Kosowsky BD, Mufti SI, Grewal GS. Effect of local lidocaine anesthesia on ventricular escape intervals during permanent pacemaker implantation in patients with complete heart block. Am J Cardiol 1983; 51: 101–104.[CrossRef][Web of Science][Medline]
[17] Jose AD. Effect of combined sympathetic and para-sympathetic blockade on heart rate and cardiac function in man. Am J Cardiol 1966; 18: 476–478.[CrossRef][Web of Science][Medline]
[18] Jordan JL, Yamaguchi I, Mandel WJ. Studies on the mechanism of sinus node dysfunction in the sick sinus syndrome. Circulation 1978; 57: 217–223.
[19] Strauss HC, Gilbert M, Svenson RH. Electrophysiological effects of propranolol on sinus node function in patients with sinus node dysfunction. Circulation 1976; 54: 452–459.
[20] Reiffel JA, Bigger JT, Giardian E-GV. ‘Paradoxical’ prolongation of sinus nodal recovery time after atropine in the sick sinus syndrome. Am J Cardiol 1975; 36: 98–104.[CrossRef][Web of Science][Medline]
[21] Bashour T, Hemb R, Wickramesekaran R. An unusual effect of atropine on overdrive suppression. Circulation 1973; 48: 911–913.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||