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Adenosine sensitivity of retrograde fast pathway conduction in patients with slow-fast atrioventricular nodal reentrant tachycardia: a prospective study.

AbstractBACKGROUND:
It is suggested that the adenosine resistance of retrograde fast pathway in slow-fast atrioventricular nodal reentrant tachycardia (AVNRT) confirms the participation of a concealed retrograde atrio-Hisian pathway rather than the conventional fast pathway in the arrhythmia circuit of slow-fast AVNRT.
OBJECTIVE:
To prospectively assess the retrograde fast pathway response to the intravenous administration of adenosine in patients with typical AVNRT and the control group.
METHODS:
Electrophysiological parameters and adenosine sensitivity of retrograde fast pathway were studied in 21 consecutive patients (18 women; mean age 57 ± 10 years) with slow-fast AVNRT and 24 patients (11 women; mean age 46 ± 16 years) as the control group.
RESULTS:
Fifteen (71%) patients with AVNRT and 18 (75%) patients in the control group developed transient ventriculoatrial (VA) block after the intravenous administration of adenosine (P = .79). In patients with slow-fast AVNRT, female sex (P = .003), longer VA interval during right ventricular pacing (P < .001), and longer tachycardia cycle length (P < .001) predicted transient VA block after the intravenous administration of adenosine. In patients in the control group, a shorter VA interval during fixed rate right ventricular apical pacing (P = .009) and the presence of dual atrioventricular nodal physiology (P = .002) were associated with the adenosine resistance of the retrograde fast pathway.
CONCLUSIONS:
The prevalence of the adenosine resistance of retrograde fast pathway's conduction is comparable between patients with and those without slow-fast AVNRT. This finding can be explained better by the existence of an insulated intranodal tract with Purkinje-like properties or a superior atrionodal connection to the nodo-Hisian region of the atrioventricular node rather than the presence of an atrio-Hisian pathway.
AuthorsElena Efimova, Sam Riahi, Lukas Fiedler, Masahiro Esato, Philipp Sommer, Sergio Richter, Ole Breithardt, Sascha Rolf, Andreas Bollmann, Gerhard Hindricks, Arash Arya
JournalHeart rhythm (Heart Rhythm) Vol. 11 Issue 5 Pg. 871-6 (May 2014) ISSN: 1556-3871 [Electronic] United States
PMID24583097 (Publication Type: Journal Article)
CopyrightCopyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Anti-Arrhythmia Agents
  • Adenosine
Topics
  • Adenosine (administration & dosage)
  • Anti-Arrhythmia Agents (administration & dosage)
  • Atrioventricular Node (drug effects, physiopathology)
  • Dose-Response Relationship, Drug
  • Electrocardiography (drug effects)
  • Female
  • Follow-Up Studies
  • Heart Rate (drug effects)
  • Humans
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Prospective Studies
  • Tachycardia, Atrioventricular Nodal Reentry (drug therapy, physiopathology)
  • Treatment Outcome

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