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(Circulation. 1997;96:1201-1208.)
© 1997 American Heart Association, Inc.
Articles |
Can Adenosine 5'-Triphosphate Be Used to Select Treatment in Severe Vasovagal Syndrome?
From Angouleme General Hospital (D.F., M.W., A.C.), Saint Michel, France; Medtronic Pacing Division (T.C., M.A.), Minneapolis, Minn; and the Division of Environmental and Occupational Health (T.C.), School of Public Health, University of Minnesota, Minneapolis.
Correspondence to Daniel Flammang, MD, Department of Cardiology, Angouleme General Hospital, 16470 Saint Michel, France.
Background Selection of treatment in vasovagal syndrome should be guided by the mechanism of symptoms. This study determined whether a simple drug test may assess one mechanism.
Methods and Results To identify patients at risk of severe
cardioinhibitory response of vagal origin, we infused 20 mg
ATP into 316 patients hospitalized for recurrent syncope (n=195) or
presyncope (n=121) of unknown origin and into normal subjects (n=51).
We then assessed the ECG and clinical responses to the drug,
recommended therapy, and followed up the subjects chronically. A
cardiac pause >10 seconds was seen in only 3 normal subjects (6%).
Therefore, a pause 
10 seconds yielded the 
95th percentile of the
normal range. ATP provoked a pause >10 seconds in 130
symptomatic patients (41%) and a pause 10 seconds in 186
symptomatic patients (59%). Thus, symptomatic
patients with pauses >10 seconds were proposed for pacemaker
implantation; all other patients and normal subjects were simply
monitored. Among long-pause patients with follow-up, the observed
recurrence rate for the 104 with pacemakers was one-third that
for the 21 who were only monitored (P<.0001). Among
followed-up short-pause patients, the rate in the 153 monitored-only
patients did not differ from the 20 implanted patients
(P=.432).
Conclusions The vagal effect of ATP may identify the subgroup of patients at high risk of severe cardioinhibitory response of vagal origin who likely will benefit from pacemaker therapy. This fast, uncomplicated test should be considered for further use in screening patients with vasovagal syndrome.
Key Words: syncope • adenosine • phosphates • vagus nerve
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