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. 1989 Sep;62(3):195–203. doi: 10.1136/hrt.62.3.195

Value and limitations of adenosine in the diagnosis and treatment of narrow and broad complex tachycardias.

A C Rankin 1, K G Oldroyd 1, E Chong 1, A P Rae 1, S M Cobbe 1
PMCID: PMC1216762  PMID: 2789911

Abstract

The diagnostic and therapeutic potential of intravenous adenosine was studied in 64 patients during 92 episodes of regular sustained tachycardia. In 40 patients who had narrow complex tachycardias (QRS less than 0.12 s) adenosine (2.5-25 mg) restored sinus rhythm in 25 with junctional tachycardias (46 of 48 episodes) and produced atrioventricular block to reveal atrial or sinus tachycardia in 15. In 24 patients with broad complex tachycardias (QRS greater than or equal to 0.12 s) adenosine terminated the tachycardias in six patients and revealed atrial or sinus arrhythmias in four. The tachycardias persisted in 14 patients despite doses up to 20 mg, but adenosine allowed the diagnosis of ventricular tachycardia with retrograde atrial activation in two patients by producing transient ventriculoatrial dissociation. Diagnosis based on adenosine induced atrioventricular nodal block was correct in all patients with narrow complex tachycardias and in 92% of those with broad complex tachycardias, compared with correct electrocardiographic diagnoses in 90% and 75% respectively. Adenosine gave diagnostic information additional to the electrocardiogram in 25%. The response to adenosine in broad complex tachycardias identified those of supraventricular origin with 90% sensitivity, 93% specificity, and 92% predictive accuracy. Adenosine restored sinus rhythm in all patients with junctional reentrant tachycardias, but in 10 (35%) the arrhythmias recurred within two minutes. Symptomatic side effects (dyspnoea, chest pain, flushing, headache) were reported by 40 (63%) patients and, although transient, were severe in 23 (36%). There were ventricular pauses of over 2 s in 16% of patients, the longest pause being 6.1 s. Adenosine is of value in the diagnosis and treatment of narrow and broad complex tachycardias, but its use is limited by symptomatic side effects, a tenfold range in minimal effective dosage, occasional action at sites other than the atrioventricular node, and early recurrence or arrhythmia.

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Selected References

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  1. Belardinelli L., Isenberg G. Isolated atrial myocytes: adenosine and acetylcholine increase potassium conductance. Am J Physiol. 1983 May;244(5):H734–H737. doi: 10.1152/ajpheart.1983.244.5.H734. [DOI] [PubMed] [Google Scholar]
  2. Buxton A. E., Marchlinski F. E., Doherty J. U., Flores B., Josephson M. E. Hazards of intravenous verapamil for sustained ventricular tachycardia. Am J Cardiol. 1987 May 1;59(12):1107–1110. doi: 10.1016/0002-9149(87)90857-5. [DOI] [PubMed] [Google Scholar]
  3. Bär F. W., Brugada P., Dassen W. R., Wellens H. J. Differential diagnosis of tachycardia with narrow QRS complex (shorter than 0.12 second). Am J Cardiol. 1984 Sep 1;54(6):555–560. doi: 10.1016/0002-9149(84)90247-9. [DOI] [PubMed] [Google Scholar]
  4. DiMarco J. P., Sellers T. D., Berne R. M., West G. A., Belardinelli L. Adenosine: electrophysiologic effects and therapeutic use for terminating paroxysmal supraventricular tachycardia. Circulation. 1983 Dec;68(6):1254–1263. doi: 10.1161/01.cir.68.6.1254. [DOI] [PubMed] [Google Scholar]
  5. Favale S., Di Biase M., Rizzo U., Belardinelli L., Rizzon P. Effect of adenosine and adenosine-5'-triphosphate on atrioventricular conduction in patients. J Am Coll Cardiol. 1985 May;5(5):1212–1219. doi: 10.1016/s0735-1097(85)80027-9. [DOI] [PubMed] [Google Scholar]
  6. Fountain S. W., Martin B. A., Musclow C. E., Cooper J. D. Pulmonary leukostasis and its relationship to pulmonary dysfunction in sheep and rabbits. Circ Res. 1980 Feb;46(2):175–180. doi: 10.1161/01.res.46.2.175. [DOI] [PubMed] [Google Scholar]
  7. Griffith M. J., Linker N. J., Ward D. E., Camm A. J. Adenosine in the diagnosis of broad complex tachycardia. Lancet. 1988 Mar 26;1(8587):672–675. doi: 10.1016/s0140-6736(88)91476-6. [DOI] [PubMed] [Google Scholar]
  8. Hutter O. F., Rankin A. C. Ionic basis of the hyperpolarizing action of adenyl compounds on sinus venosus of the tortoise heart. J Physiol. 1984 Aug;353:111–125. doi: 10.1113/jphysiol.1984.sp015326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Klabunde R. E. Dipyridamole inhibition of adenosine metabolism in human blood. Eur J Pharmacol. 1983 Sep 16;93(1-2):21–26. doi: 10.1016/0014-2999(83)90026-2. [DOI] [PubMed] [Google Scholar]
  10. Lerman B. B., Belardinelli L., West G. A., Berne R. M., DiMarco J. P. Adenosine-sensitive ventricular tachycardia: evidence suggesting cyclic AMP-mediated triggered activity. Circulation. 1986 Aug;74(2):270–280. doi: 10.1161/01.cir.74.2.270. [DOI] [PubMed] [Google Scholar]
  11. Morgan D. E., Brennan F. J. Diagnostic potential for verapamil in wide QRS complex tachycardia. Am J Cardiol. 1985 May 1;55(11):1428–1429. doi: 10.1016/0002-9149(85)90521-1. [DOI] [PubMed] [Google Scholar]
  12. Munoz A., Leenhardt A., Sassine A., Galley P., Puech P. Therapeutic use of adenosine for terminating spontaneous paroxysmal supraventricular tachycardia. Eur Heart J. 1984 Sep;5(9):735–738. doi: 10.1093/oxfordjournals.eurheartj.a061734. [DOI] [PubMed] [Google Scholar]
  13. Perelman M. S., Krikler D. M. Termination of focal atrial tachycardia by adenosine triphosphate. Br Heart J. 1987 Nov;58(5):528–530. doi: 10.1136/hrt.58.5.528. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Perrot B., Clozel J. P., Faivre G. Effect of adenosine triphosphate on the accessory pathways. Eur Heart J. 1984 May;5(5):382–393. doi: 10.1093/oxfordjournals.eurheartj.a061672. [DOI] [PubMed] [Google Scholar]
  15. Rankin A. C., Rae A. P., Cobbe S. M. Misuse of intravenous verapamil in patients with ventricular tachycardia. Lancet. 1987 Aug 29;2(8557):472–474. doi: 10.1016/s0140-6736(87)91790-9. [DOI] [PubMed] [Google Scholar]
  16. Rinne C., Sharma A. D., Klein G. J., Yee R., Szabo T. Comparative effects of adenosine triphosphate on accessory pathway and atrioventricular nodal conduction. Am Heart J. 1988 May;115(5):1042–1047. doi: 10.1016/0002-8703(88)90074-9. [DOI] [PubMed] [Google Scholar]
  17. Stewart R. B., Bardy G. H., Greene H. L. Wide complex tachycardia: misdiagnosis and outcome after emergent therapy. Ann Intern Med. 1986 Jun;104(6):766–771. doi: 10.7326/0003-4819-104-6-766. [DOI] [PubMed] [Google Scholar]
  18. Sylvén C., Jonzon B., Brandt R., Beermann B. Adenosine-provoked angina pectoris-like pain--time characteristics, influence of autonomic blockade and naloxone. Eur Heart J. 1987 Jul;8(7):738–743. doi: 10.1093/eurheartj/8.7.738. [DOI] [PubMed] [Google Scholar]
  19. Watt A. H., Bernard M. S., Webster J., Passani S. L., Stephens M. R., Routledge P. A. Intravenous adenosine in the treatment of supraventricular tachycardia: a dose-ranging study and interaction with dipyridamole. Br J Clin Pharmacol. 1986 Feb;21(2):227–230. doi: 10.1111/j.1365-2125.1986.tb05180.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Watt A. H., Reid P. G., Stephens M. R., Routledge P. A. Adenosine-induced respiratory stimulation in man depends on site of infusion. Evidence for an action on the carotid body? Br J Clin Pharmacol. 1987 Apr;23(4):486–490. doi: 10.1111/j.1365-2125.1987.tb03081.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Watt A. H., Routledge P. A. Transient bradycardia and subsequent sinus tachycardia produced by intravenous adenosine in healthy adult subjects. Br J Clin Pharmacol. 1986 May;21(5):533–536. doi: 10.1111/j.1365-2125.1986.tb02838.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Wellens H. J., Bär F. W., Lie K. I. The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. Am J Med. 1978 Jan;64(1):27–33. doi: 10.1016/0002-9343(78)90176-6. [DOI] [PubMed] [Google Scholar]
  23. West G. A., Belardinelli L. Correlation of sinus slowing and hyperpolarization caused by adenosine in sinus node. Pflugers Arch. 1985 Jan;403(1):75–81. doi: 10.1007/BF00583285. [DOI] [PubMed] [Google Scholar]
  24. Wu D., Denes P., Amat-y-Leon F., Dhingra R., Wyndham C. R., Bauernfeind R., Latif P., Rosen K. M. Clinical, electrocardiographic and electrophysiologic observations in patients with paroxysmal supraventricular tachycardia. Am J Cardiol. 1978 May 22;41(6):1045–1051. doi: 10.1016/0002-9149(78)90856-1. [DOI] [PubMed] [Google Scholar]
  25. diMarco J. P., Sellers T. D., Lerman B. B., Greenberg M. L., Berne R. M., Belardinelli L. Diagnostic and therapeutic use of adenosine in patients with supraventricular tachyarrhythmias. J Am Coll Cardiol. 1985 Aug;6(2):417–425. doi: 10.1016/s0735-1097(85)80181-9. [DOI] [PubMed] [Google Scholar]

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