Which tests are performed in the workup of sinus node dysfunction (SND)?

Updated: Nov 30, 2018
  • Author: Bharat K Kantharia, MD, FRCP, FAHA, FACC, FESC, FHRS; Chief Editor: Mikhael F El-Chami, MD  more...
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See also the Guidelines section for recommendations from the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society for the evaluation and management of bradycardia and disorders of cardiac conduction delay.

For patients in whom sinus node dysfunction (SND) is clinically suspected but not confirmed by electrocardiography (ECG) and/or exercise stress test findings, a number of different modalities may be helpful. In most patients, ambulatory ECG monitoring for an extended period of time (typically 2-4 weeks but potentially longer) has the greatest yield and allows for correlation with symptoms. In select patients in whom the diagnosis remains uncertain, other diagnostic testing options include adenosine administration, carotid sinus massage, and invasive electrophysiologic (EP) studies. 

The introduction of the implantable loop monitor has also enhanced the diagnostic yield of the clinical evaluation if symptoms are intermittent, extending over weeks to months.

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