Mechanism of syncope in patients with positive adenosine triphosphate tests
Open accessAbstract
Objectives We prospectively evaluated the mechanism of syncope in patients with positive adenosine triphosphate (ATP) tests (defined as the induction of atrioventricular [AV] block with a ventricular pause >/=6 s after an intravenous bolus of 20 mg ATP).Background Patients with unexplained syncope tend to have more positive ATP tests results than those without syncope.Methods An implantable loop recorder (ILR) was inserted in 36 ATP-positive patients (69 +/- 10 years; 22 women; median of 6 syncopal episodes); 15 of them also had a positive response to tilt testing.Results During the follow-up of 18 +/- 9 months, 18 patients (50%) had syncopal recurrence and 16 (44%) had an electrocardiographically documented episode: AV block (n = 3: paroxysmal in 2 and permanent in 1), AV block followed by sinus arrest (n = 1), sinus arrest (n = 5), sinus bradycardia <40 beats/min (n = 2), normal sinus rhythm (n = 2), sinus tachycardia (n = 1), rapid atrial fibrillation (n = 1), and ectopic atrial tachycardia (n = 1). Bradycardia was documented in a total of 11 cases (69%), and a long ventricular pause (4 to 29 s) was present in eight cases (50%). All three patients with ILR-documented AV block had previously had a negative tilt test, whereas seven of eight with ILR-documented sinus bradycardia or sinus arrest had previously had a positive tilt test.Conclusions In patients with adenosine-sensitive syncope, the mechanism of syncope is heterogeneous, although bradycardia is the most frequent finding. Adenosine triphosphate-induced AV block predicts AV block as the mechanism of spontaneous syncope in only a few tilt-negative patients.
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Cardiac pacing may lead to substantial reduction of syncopal attacks in elderly patients with unexplained syncope and a positive ATP test.
“Although cardiac pacing may lead to substantial reduction of syncopal attacks in elderly patients with unexplained syncope and a positive ATP test, 229”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [229]
The Discussion (page not specified) acknowledges a possible beneficial effect of pacing and reports that syncope recurred in 13% of paced patients with positive ATP tests in a non-controlled study. It calls the pacing results inconclusive, however, and says the apparent benefit was independent of ATP-test results. It therefore does not establish a substantial reduction specifically for elderly ATP-positive patients. (LLM, conf=0.85)
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Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040 · see citing works
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- Authors
- Donateo, P., Brignole, M., Menozzi, C., Bottoni, N., Alboni, P., Dinelli, M., Del Rosso, A., Croci, F., Oddone, D., Solano, A., & Puggioni, E.
- Affiliations
- Presidio Ospedaliero (IT)
- Santa Maria Nuova Hospital (IT)
- Corresponding author
- Brignole, Michele
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2003-01
- Volume
- 41
- Issue
- 1
- Pages
- 93-98
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2154605051
- Cited by
- 68
- References
- 14
- Citations by year
- 2025: 1 · 2022: 1 · 2021: 2 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 4 · 2014: 2 · 2013: 3 · 2012: 3
- FWCI
- 3.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- syncope, atrioventricular block, sinus arrest, sinus bradycardia, ventricular pause, implantable loop recorder, tilt table test, syncope recurrence, syncope mechanism
- MeSH terms
- Adenosine Triphosphate, Adult, Aged, Aged, 80 and over, Arrhythmias, Cardiac, Diagnostic Techniques, Cardiovascular, Diagnostic Techniques, Neurological, Female, Heart Block, Humans, Injections, Intravenous, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Recurrence, Syncope, Implants, Experimental
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