Transoesophageal atrial pacing predicts clinical course of moderate sinus node dysfunction better than ECG Holter monitoring.

Background: Cost-effectiveness of pacemaker implantation in patients with m oderate to benign sinus node dysfunction remains unclear. Methods and study group: The study group consisted of 78 consecutive patien ts (39 males, mean age 64 years) who underwent Holter ECG and transoesophag eal atrial pacing (TAP) for bradycardia-related complaints and were disqual ified from pacemaker implantation because of borderline Holter and TAP resu lts. The patients were followed for a mean of 33 months. Results: Only 26 patients (33%) required implantation due to recurrence or worsening of symptoms. The Holter results (maximal, minimal and mean HR, HR V parameters) were similar in implanted and non-implanted groups. TAP param eters: sinus node recovery time (SNRT), corrected sinus node recovery time (CSNRT), total sinus node recovery time (TSNRT), sinoatrial conduction time by Strauss (SACT-S) and by Narula (SACT-N) were prolonged in implanted gro up, however there were no significantly different when compared with non-im planted group. Analysis of cut-off values of these parameters: SNRT > 1600 ms, CSNRT > 550 ms, TSNRT > 5000 ms, SACT-S > 200 ms and SACT-N > 380 ms an d for combined parameter (COM) = SNRT > 1600 ms and TSNRT > 5500 ms have sh own that CSNRT had the best sensitivity (58%) and negative predictive value (78%), and COM had the best specificity (98%) and positive predictive valu e (86%) in predicting the need for pacemaker implantation. Conclusion: Electrophysiologic parameters of sinus node automaticity but no t Holter ECG may predict need for pacemaker implantation in patients with b enign to moderate sinus node dysfunction.