Limited dose-effect relationship of adenosine for detection of atrioventricular nodal duality in patients with supraventricular tachycardias.
OBJECTIVE
The purpose of the study was to test the dose-effect relationship of adenosine for the diagnosis of dual atrioventricular (AV) nodal physiology in patients presenting with supraventricular tachycardia.


METHODS
The study population consisted of 57 patients (mean age 50 +/- 14 years; 36 females, 21 males) with palpitations related to supraventricular tachycardia. Adenosine was injected as bolus during sinus rhythm at rest in order to unmask dual AV nodal physiology by a PR jump on surface ECG (defined as a sudden increase by > or = 50 ms measured from the onset of the P-wave to the R-wave between two consecutive sinus beats). According to a stepwise clinical approach, adenosine was administered as bolus in incremental dosages (6 mg followed by 12 mg, if necessary up to 18 mg). Once a PR jump > or = 50 ms or a high-grade AV block was noted on surface ECG, the injection was stopped at that dose.


RESULTS
A significant PR jump was noted after injection of 6 mg (n = 21, 99 +/- 30 ms) or 12 mg (n = 13, 94 +/- 35 ms), but not after 18 mg (n = 4, 35 +/- 10 ms) adenosine. Provocation of temporary first-grade AV block (n = 13) was associated with the longest increment of PR interval, whereas high-grade AV block (n = 36) produced a significantly shorter PR jump (105 +/- 35 vs. 65 +/- 40 ms, p = 0.0024). Electrophysiological study and ablation were performed in 37 highly symptomatic patients. AV nodal reentrant tachycardia was diagnosed in 33 patients and orthodromic AV reentrant tachycardia in 4 patients.


CONCLUSIONS
The adenosine test was characterized by a reverse dose-effect relationship as far as identification of AV nodal duality was concerned.
Schernthaner
Christiana
C
Department of Cardiology, Salzburger Landeskliniken, Paracelsus Private Medical University, Salzburg, Austria. c.schernthaner@salk.at
Pichler
Maximilian
M
Strohmer
Bernhard
B
D000241:Adenosine; D000889:Anti-Arrhythmia Agents; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis*
D000889:Anti-Arrhythmia Agents; D000241:Adenosine