Epidemiology, clinical features, and follow-up of patients with syncope and a positive adenosine triphosphate test result

OBJECTIVES We sought to evaluate epidemiology, clinical features, and outcomes of patients with syncope and an abnormal response to adenosine triphosphate (ATP). BACKGROUND Syncope remains of unknown origin in almost 30% of the patients. Injection of ATP induces in some of these patients, but not in control patients, a ventricular pause >= 6 s. METHODS Patients with syncope of unknown origin had an intravenous injection of 20 mg of ATP. All patients had a tilt test. RESULTS Among 214 patients, 19 (8.9%) had a positive ATP test result. The proportion of positive test results was higher (p < 0.002) in women (14.3%) than in men (2.2%). Ten patients (4.7%) had positive ATP and tilt test results. These patients (exclusively women) were older (p < 0.05) at the time of their fist syncope than the 67 patients with a negative ATP test result but a positive tilt test result. There was a trend for these two test results to be correlated (p 0.07). Side effects were of short duration and benign. The mean duration of pauses was longer in women (p = 0.009). During a mean period of 31 +/- 14 months, recurrences of syncope were reported in 25% of patients. CONCLUSIONS The ATP test is a safe test with an abnormal result in <10% of patients with syncope of unknown origin. The profile of these patients is characteristic.