In the evaluation of preoperative anesthesia visits for surgical procedures, the author often sees an electrocardiogram with sinus bradycardia in the medical record. What is the reliability of the atropine test alone in clinical practice? What should we do if we encounter a patient with a positive atropine test? The atropine test was first proposed by the German physician Dehio (1851-1927). Its main significance is to diagnose sinus syndrome, to distinguish organic from functional atrioventricular block, to determine the site of high or complete atrioventricular block, and to distinguish sinus bradycardia due to vagal hypertension, drug factors, cardiac trauma, family history, etc. Atropine experiments were performed with electrocardiograms as a control, followed by 1.5-2 mg of atropine, and a II-lead electrocardiogram was measured once at 1, 2, 3, 5, 10, 15 and 20 min immediately after injection. It is usually considered as positive if the sinus heart rate increases within the above time after injection, <90 beats/min, or nodal rhythm appears; it is negative if the sinus heart rate increases ≥90 beats/min, or the original sinus block or sinus quiescence disappears. This test can assist in the diagnosis of sinus bradycardia as a diseased sinus syndrome, with a positive result suggesting sinus node malfunction and a negative result revealing parasympathetic hyperfunction. However, after about 100 years of clinical use, it has been found that the atropine test has a high degree of false positives and false negatives, and is not very sensitive or specific. With the advent of medicine, 24-hour ambulatory electrocardiography, echocardiography, and cardiography are now available to provide patients with more definitive and reliable information. Of course, what is the most effective way to assess cardiac function? Without a doubt: it is the medical history and physical examination! Exercise endurance is the most reliable method of assessing cardiac function. Is it necessary to worry about a patient with a basal heart rate of 45 beats, who usually walks 50 miles with a load, sleeps flat on his back at night, and never faints due to a slow heart rate, even if the atropine test is a positive one? On the other hand, if the patient is very sick and has conduction block, even if the atropine test is negative, we should not take it lightly! In addition, it has been reported in the literature that during the atropine test, the patient's heart rate increases and myocardial oxygen consumption increases, which has the risk of causing myocardial ischemia, ventricular arrhythmia and even cardiac arrest. With the development of modern medicine and the increasing conflicts between doctors and patients in China, medical personnel now tend to have a deeper understanding of the auxiliary tests, and I believe that relying solely on the atropine test as the main means of determining sinus bradycardia is not comprehensive! Inaccurate, need to update the concept! Updated knowledge! Preoperative evaluation of the patient is a comprehensive examination and decision making process. How can a doctor with a modern medical education decide whether to operate on the basis of a negative or positive result alone? Not to mention that this test is a one-sided and does not reflect the essence of the condition. The author believes that it should be analyzed comprehensively in conjunction with 24-hour ambulatory ECG, echocardiography and other tests. If the diagnosis of sinus bradycardia is more detailed! If the diagnosis of sinus bradycardia is more refined, the treatment is more precise, which is of great significance to avoid cardiovascular accidents in the perioperative period and to protect the medical safety of patients!