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

Vavetsi, Spiridoula; Νικολάου, Νικόλαος; Tsarouhas, Konstantinos; Lymperopoulos, Georgios; Kouzanidis, Ioannis; Kafantaris, Ioannis; Antonakopoulos, Athanasios; Tsitsimpikou, Christina; Kandylas, John

doi:10.1093/europace/eun211

Cited by 11 publications

(4 citation statements)

References 19 publications

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“…These include atrial electroanatomic remodeling, previous cardiac surgery, decreased left ventricular ejection fraction, and increased temporal recovery of the sinus node function (Daoud et al, 2002;Koplan et al, 2003;Sairaku et al, 2012). Direct damage to the sinus node or sinus node blood supply during cardiac surgery has been suggested as the causal mechanism (Nerantzis et al, 2021), als with asymptomatic sinus bradycardia when there is an abnormal response to both atropine (<90 bpm) and isoproterenol (<120 bpm) (Vavetsi et al, 2008). The present case also showed a poor response to atropine and isoproterenol.…”

Section: Discussionmentioning

confidence: 56%

“…Atropine can return an acute SND condition to a normal sinus rhythm (Wallace et al, 2021), and Spiridoula. el found that combined atropine–isoproterenol tests can evaluate the indication for preventive permanent pacemaker implantation in individuals with asymptomatic sinus bradycardia when there is an abnormal response to both atropine (<90 bpm) and isoproterenol (<120 bpm) (Vavetsi et al, 2008). The present case also showed a poor response to atropine and isoproterenol.…”

Section: Discussionmentioning

confidence: 99%

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Sinus node dysfunction after radiofrequency catheter ablation of atrial flutter: A case report

Wang

2022

Noninvasive Electrocardiol

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A 65-year-old man (weight 73 kg, height 170 cm; BMI = 25.2 kg/ m 2 ) had occasionally shown persistent atrial flutter (AFL) on physical examination for 1 year. His past medical history included hypertension, hyperlipidemia, premature ventricular contraction, and nonsustained ventricular tachycardia. There was no history of smoking or drinking. He was asymptomatic during AFL, and his resting electrocardiogram (ECG) is shown in Figure 1, and no prior sinus ECG was available until the patient was diagnosed with AFL.Typical AFL was diagnosed when a surface ECG showed typical flutter waves that were predominantly negative in leads II, III, and aVF, and positive in lead V 1 , with a regular atrial rate. Laboratory examinations after admission were normal (Table 1). The results of transthoracic echocardiography revealed left (55 × 67 × 81 mm) and right (42 × 60 mm) atrial enlargement, while transesophageal echocardiography did not identify the presence of thrombus in the atrium. | MANAG EMENT (MED I C AL / INTERVENTI ON S) AND OPER ATI ON PRO CE SSThe administration of all antiarrhythmic agents was discontinued ≥5 half-lives before the electrophysiology procedure, and a signed consent form was obtained from the patient. Cavotricuspid isthmus (CTI)-dependent AFL was considered based on the previous ECG (Figure 1) with an atrial flutter cycle length (FCL) of 260 ms.The procedure included routine disinfection, cloth covering, and local anesthesia with 1% lidocaine, puncture of the right femoral vein, and the sending of 10-pole electrodes (St. Jude Medical) and ablation electrodes (Biosense Webster) to the coronary sinus (CS) and right ventricle, respectively, through a 6F sheath tube. A decapolar catheter with 4-mm interelectrode spacing was inserted into the CS, with the proximal bipole located at its ostium. Intracardiac electrophysiological examination showed that the activation order of the CS was from proximal to distal and CTI-dependence was confirmed

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Sinus node dysfunction after radiofrequency catheter ablation of atrial flutter: A case report

Wang

2022

Noninvasive Electrocardiol

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“…To some extent, HR max might represent the HR reserve, and compromised HR max value should be related to injured HR reserve, resulting in tendency to RVP dependence. It was reported that HR reserve could partly represent the function of cardiac conduction system, especially the sinus node function, 23,24 and this offered indirect evidence to support this perspective. Nevertheless, ROC analysis disclosed that HR max failed to accurately predict RVP dependence ( Figure ).…”

Section: Discussionmentioning

confidence: 99%

Risk factors of pacing dependence and cardiac dysfunction in patients with permanent pacemaker implantation

Liang

Xiao

et al. 2022

ESC Heart Failure

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Aims Right ventricular pacing (RVP) dependence could impair left ventricular ejection fraction (LVEF). This study aimed to illuminate the relationship between RVP proportion and LVEF, as well as disclosing independent predictors of RVP dependence. Methods and resultsPatients indicated for permanent pacemaker implantation were included (2016-2020). The ventricular pacing lead was placed in right ventricular apex or septum. Pacing mode programming followed universal standard. Electrocardiographic, echocardiographic, and serological parameters were collected. RVP dependence was defined according to its influence on LVEF. This study was of case-control design. Included patients were matched by potentially confounding factors through propensity score matching. A total of 1183 patients were included, and the mean duration of follow-up was 24 months. Percentage of RVP < 80% hardly influenced LVEF; however, LVEF tended to decrease with higher RVP proportion. High degree/complete atrioventricular block (AVB) [odds ratio (OR) = 5.71, 95%

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“…The possibility of irreversible lesions of the sinus node should be considered if there is no or slight response to atropine; however, these outcomes cannot completely rule out the vagal inhibitory effect. The following conditions may contribute to a mismatch between the AT outcomes and the actual situation: 1) using a conventional dose of atropine in overweight or obese subjects is not sufficient to provoke noticeable response owing to the limitation in maximum dosage; low-dose atropine may in cause paradoxical bradycardia ( Mandel et al, 1972 ); 2) subjects are insensitive to atropine; 3) Differences in the amount and quality of the cholinergic receptors among individuals ( Vavetsi et al, 2008 ); 4) taking drugs that would suppress sinus node pacemaking; 5) high sympathetic tone partially masks the intrinsic sinus node involvement.…”

Section: Selection Criteria For Patients Undergoing Cardioneuroablati...mentioning

confidence: 99%

Selection of patients with symptomatic vagal-induced sinus node dysfunction: Who will be the best candidate for cardioneuroablation?

2023

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Sinus node dysfunction is a multifaceted disorder with variable manifestations, the prevalence of which increases with age. In a specific group of patients, excessive vagal activity may be the sole cause for this condition. These patients are characterized as having recurrent daytime symptoms attributed to bradyarrhythmia, no evidence of organic sinus node lesions, cardiac vagal overactivation, and are non-elderly. For sinus node dysfunction patients, a permanent pacemaker implantation appears to be the ultimate solution, although it is not an etiological treatment. Cardioneuroablation is a promising emerging therapy that can fundamentally eliminate symptoms in a highly selective sub-set of sinus node dysfunction patients by cardiac vagal nerve denervation. Denervation with ablation for vagal-induced sinus node dysfunction can effectively improve sinus bradycardia and reduce syncope. To date, guidelines for selection of suitable candidates for cardioneuroablation remain lacking. The primary objective of this study was to distinguish the nature of abnormal sinus node function and to find methods for quantifying vagal tone. Clear selection criteria could help physicians in identification of patients with autonomic imbalance, thereby maximizing patient benefits and the success rate of cardioneuroablations.

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

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

Cited by 11 publications

References 19 publications

Sinus node dysfunction after radiofrequency catheter ablation of atrial flutter: A case report

Sinus node dysfunction after radiofrequency catheter ablation of atrial flutter: A case report

Risk factors of pacing dependence and cardiac dysfunction in patients with permanent pacemaker implantation

Selection of patients with symptomatic vagal-induced sinus node dysfunction: Who will be the best candidate for cardioneuroablation?

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