Bedside evaluation of sinus bradycardia: Usefulness of atropine test in discriminating organic from autonomic involvement of sinus automaticity

Riccardo Cappato, Paolo Alboni, Nelly Paparella, Tiziano Toselli, Gian Carlo Candini, Anna M. Tomasi

Research output: Contribution to journalArticlepeer-review

Abstract

In 55 patients with persistent sinus bradycardla who underwent an electrophysiologic study of sinus node, both in the basal state and after autonomic blockade (propranolol, 0.2 mg/kg, and atropine, 0.04 mg/kg), an atropine test (0.02 mg/kg) was performed the following day. The 49 patients in whom sinus rate could be evaluated after atropine were subdivided into two groups-group I, 24 patients (age: 54 ± 13 years) with normal intrinsic sinus automaticity (normal intrinsic heart rate and intrinsic corrected sinus node recovery time) and group II, 25 patients (age: 62 ± 9 years) with abnormal intrinsic sinus automaticity. In group I, atropine increased sinus rate from 53.7 ± 4 to 87.9 ± 17 bpm (Δ%: 65.5 ± 33) and in group II from 51.6 ± 5 to 73.9 ± 14 bpm (Δ%: 43.1 ± 26). The discriminant threshold of sinus rate after atropine and its percent increase, obtained by discriminant analysis, was 80 bpm and +52%, respectivoly, with a misleading classification of 32% and 36%, respectively. The overall predictive accuracy of sinus rate after atropine was higher than the percent change in sinus rate (73% and 65%, respectively). These data evidence that the atropine test is not very helpful in discriminating between an organic and an autonomic involvement of sinus automaticity in patients with sinus bradycardia.

Original languageEnglish
Pages (from-to)1384-1388
Number of pages5
JournalAmerican Heart Journal
Volume114
Issue number6
DOIs
Publication statusPublished - 1987

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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