Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-24T02:10:11.544Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of adenosine on atrioventricular conduction in children and young patients with supraventricular tachycardia

Published online by Cambridge University Press:  19 August 2008

Parvin C. Dorostkar ,
Macdonald Dick II ,
Gerald A. Serwer ,
Sarah LeRoy  and
Brian Armstrong
Parvin C. Dorostkar
Affiliation:
From the Division of Pediatric Cardiology, C. S. Mott Children's Hospital and the Department of Pediatrics, University of Michigan, Ann Arbor
Macdonald Dick II*
Affiliation:
From the Division of Pediatric Cardiology, C. S. Mott Children's Hospital and the Department of Pediatrics, University of Michigan, Ann Arbor
Gerald A. Serwer
Affiliation:
From the Division of Pediatric Cardiology, C. S. Mott Children's Hospital and the Department of Pediatrics, University of Michigan, Ann Arbor
Sarah LeRoy
Affiliation:
From the Division of Pediatric Cardiology, C. S. Mott Children's Hospital and the Department of Pediatrics, University of Michigan, Ann Arbor
Brian Armstrong
Affiliation:
From the Division of Pediatric Cardiology, C. S. Mott Children's Hospital and the Department of Pediatrics, University of Michigan, Ann Arbor
*
Dr. Macdonald Dick II, F1310 Box 0204, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, 48109–0204, USA. Tel. (313) 764–5176; Fax. (313) 936–9470.
Get access Rights & Permissions [Opens in a new window]

Abstract

Adenosine, when given as an intravenous bolus, has been shown to produce atrioventricular nodal block in humans. To examine the effect of adenosine on conduction across both accessory pathways and the atrioventricular node in children, we reviewed our experience with adenosine administered during both atrial and ventricular pacing in 42 patients with atrioventricular resting tachycardia and in eight patients with atrioventricular nodal reentry tachycardia. Adenosine was administered as a mean bolus of 195 μg/kg/dose during both atrial and ventricular pacing, examining antegrade and retrograde conduction before and after radiofrequency ablation. In those patients with persistent or intermittent pre-excitation, anomalous ventricular activation was either unchanged (n=8) or increased (n=11). Retrograde conduction (either through the accessory pathway alone in three, or across both the accessory pathway and the atrioventricular node in 19) persisted in 92% of the 24 patients studied. Adenosine produced either first or third degree antegrade heart block in all patients studied without pre-excitation (those with either dual atrioventricular nodal pathways or concealed accessory pathways). Adenosine produced retrograde block in all of the eight patients with dual atrioventricular nodal pathways. In contrast, retrograde conduction persisted in 82% (14/17) of patients with concealed accessory pathways (p=0.001). When used to examine retrograde conduction, adenosine was a sensitive (82%) and highly specific (producing retrograde atrioventricular block in all patients with dual atrioventricular nodal pathways) predictor of tachycardia supported by a concealed accessory pathway. Adenosine yielded a sensitivity and specificity of 96% and a positive predictive value of 99.5% for the success of ablation of accessory pathways. These data indicate that the pattern of adenosine-induced changes in either antegrade or retrograde atrioventricular conduction, or conduction in both directions, in young patients with supraventricular tachycardia is related to the mechanism of the tachycardia. Adenosine, therefore, is a useful adjunct in the electrophysiologic evaluation of supraventricular tachycardia in children.

Keywords

Accessory pathwayarrhythmiaatrioventricular node
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 6 , Issue 4 , October 1996 , pp. 308 - 314
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Drury, AN, Szent-Gyorgyi, A. The physiological activity of adenine compounds with special reference to their action upon the mammalian heart. J Physiol 1929; 68: 214–237.CrossRefGoogle Scholar
2.Belardinelli, L, Linden, J, Berne, RM. The cardiac effects of adenosine. Prog Cardiovasc Dis 1989; 32: 73–79.CrossRefGoogle ScholarPubMed
3.Lerman, BB, Belardinelli, L. Cardiac electrophysiology of adenosine: basic and clinical concepts. Circulation 1991; 83: 1499–1509.CrossRefGoogle ScholarPubMed
4.Sharma, AD, Klein, GJ. Comparative quantitative electrophysiologic effects of adenosine triphosphate on the sinus node and atrioventricular node. Am J Cardiol 1988; 61: 330–335.CrossRefGoogle ScholarPubMed
5.Overholt, ED, Rheuban, KS, Gutgesell, HP, Lerman, BB, DiMarco, JP. Usefulness of adenosine for arrhythmias in infants and children. Am J Cardiol 1988; 61: 336–340.CrossRefGoogle ScholarPubMed
6.Lauer, MR, Young, C, BingLiem, L, Sung, RJ. Efficacy of adenosine in terminating catecholamine-dependent supraven-tricular tachycardia. Am J Cardiol 1994; 73: 38–42.CrossRefGoogle ScholarPubMed
7.Belhassen, B, Pelleg, A, Shoshani, D, Geva, B, Laniado, S. Electrophysiologic effects of adenosine-5'-triphosphate on atrioventricular reentrant tachycardia. Circulation 1983; 68: 827–833.CrossRefGoogle ScholarPubMed
8.DiMarco, JP, Sellers, TD, Lerman, BB, Greenberg, ML, Berne, RM, Belardinelli, L. Diagnostic and therapeutic use of adenosine in patients with supraventricular tachyarrhythmias. J Am Coll Cardiol 1985; 6: 417–425.CrossRefGoogle ScholarPubMed
9.DiMarco, JP, Sellers, TD, Berne, RM, West, GA, Belardinelli, L. Adenosine: electrophysiologic effects and therapeutic use for terminating paroxysmal supraventricular tachycardia. Circulation 1983; 68: 1254–1263.CrossRefGoogle ScholarPubMed
10.Clarke, B,Till, J,Rowland, E, Ward, DE, Barnes, PJ, Shinebourne, EA. Rapid and safe termination of supraventricular tachycardia in children by adenosine. Lancet 1987; 1: 299–300.CrossRefGoogle ScholarPubMed
11.Rossi, AF, Burton, DA. Adenosine in altering short- and long-term treatment of supraventricular tachycardia in infants. Am J Cardiol 1989:64:685–686.CrossRefGoogle Scholar
12.Till, J, Shinebourne, EA, Rigby, ML, Clarke, B, Ward, DE, Rowland, E. Efficacy and safety of adenosine in the treatment of Supraventricular tachycardia in infants and children. Br Heart J 1989; 62: 204–211.CrossRefGoogle ScholarPubMed
13.DiMarco, JP, Miles, W, Akhtar, M, Milstein, S, Sharma, AD, Platia, E, McGovern, B, Scheinman, MM, Govier, WC. Adenosine for paroxysmal supraventricular tachycardia: dose ranging and comparison with verapamil. Assessment in placebo-controlled, multicenter trials. Ann Int Med 1990; 113: 104–110.CrossRefGoogle ScholarPubMed
14.Dick, M, O'Connor, BK, Serwer, GA, LeRoy, S, Armstrong, B. Use of radiofrequency current to ablate accessory pathways in children. Circulation 1991; 84: 2318–2324.CrossRefGoogle ScholarPubMed
15.O'Connor, BK, Dick II, M. What every pediatrician should know about supraventricular tachycardia. Pediatr Ann 1991; 20: 368–376.CrossRefGoogle ScholarPubMed
16.Calkins, H, Sousa, J, El-Atassi, R, Rosenheck, S, DeButtleir, M, Kou, WH, Kadish, AH, Langberg, JJ, Morady, F. Diagnosis and cure of the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardias during a single electrophysiologic test. N Engl J Med 1991; 324: 1612–1618.CrossRefGoogle ScholarPubMed
17.Jackman, WM, Beckman, KJ, McClelland, JH, Wang, X, Friday, KJ, Roman, CA, Moulton, KP, Twidale, N, Hazlitt, HA, Prior, MI, Oren, J, Overholt, ED, Lazarra, R. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency ablation of slow-pathway conduction. N Engl J Med 1992; 327: 313–318.CrossRefGoogle ScholarPubMed
18.Garrat, CJ, Antoniou, A, Griffith, MJ, Ward, DE, Camm, AJ. Use of adenosine in sinus rhythm as a diagnostic test for latent pre–excitation. Am J Cardiol 1990; 65: 868–873.CrossRefGoogle Scholar
19.Keim, S, Curtis, AB, Belardinelli, L, Epstein, ML, Staples, ED, Lerman, BB. Adenosine-Induced Atrioventricular Block: A rapid and reliable method to assess surgical and radiofrequency catheter ablation of accessory atrioventricular pathways. J Am Coll Cardiol 1992; 19: 1005–1012.CrossRefGoogle ScholarPubMed
20.Cohen, TJ, Tucker, KJ, Abbott, JA, Botvinick, EH, Foster, E, Schiler, NB, O'Connell, JW, Scheinman, MM. Usefulness of adenosine in augmenting ventricular pre-excitation for noninvasive localization of accessory pathways. Am J Cardiol 1992; 69: 1178–1185.CrossRefGoogle Scholar
21.Perrot, B, Clozel, JP, Faivre, G. Effect of adenosine triphosphate on the accessory pathways. Eur Heart J 1984; 5: 382–393.CrossRefGoogle ScholarPubMed
22.Rinne, C, Sharma, AD, Klein, GJ, Yee, R, Szabo, T. Comparative effects of adenosine triphosphate on accessory pathway and atrioventricular nodal conduction. Am Heart J 1988; 115: 1042.CrossRefGoogle ScholarPubMed
23.Klitzner, TS, Stevenson, WG. Age related changes in accessory pathway conduction in children with the Wolff-Parkinson-White syndrome. Circulation 1990; 82(Suppl III): III880.Google Scholar
24.Crosson, JE, Tang, C, Etheridge, SP, Hesslein, PS, Milstein, S, Dunnigan, A. Does adenosine help differentiate between retrograde atrioventricular node and retrograde accessory pathway conduction? J Am Coll Cardiol 1994; 24: 368A. [Abstract]Google Scholar
25.Kou, WH, Morady, F, Dick, M, Nelson, SD, Baerman, JM. Concealed anterograde accessory pathway conduction during the induction of orthodromic reciprocating tachycardia. J Am Coll Cardiol 1989; 13: 391–398.CrossRefGoogle ScholarPubMed
26.Sung, RJ, Gelband, H, Castellanos, A, Aranda, JM, Myerberg, RJ. Electrophysiologic observations in patients with concealed accessory atrioventricular bypass tract. Am J Cardiol 1977; 40: 839–847.CrossRefGoogle Scholar
27.Klein, GJ, Yee, R, Sharma, AD. Concealed conduction in accessory pathways: an important determinant of the expression of arrhythmias in patients with Wolff-Parkinson-White syndrome. Circulation 1984; 70: 402–411.CrossRefGoogle ScholarPubMed
28.Kuck, KH, Kunze, KP, Geiger, M. Concealed accessory pathways: prevention of pre-excitation by permanent antegrade block at the ventricular insertion of accessory pathway. J Am Coll Cardiol 1987; 9: 13A. [Abstract]Google Scholar
29.O'Callaghan, WG, Colavita, PG, Kay, GN, Ellenbogen, KA, Gilbert, MR, German, LD. Characterization of retrograde conduction by direct endocardia! recording from an accessory atrioventricular pathway. J Am Coll Cardiol 1986; 7: 167–171.CrossRefGoogle Scholar
30.Jackman, WM, Friday, KJ, Sherlag, BJ, Denning, MM, Schechter, E, Reynolds, DW, Olson, EG, Berbara, EJ, Harrison, LA, Lazzara, R. Direct endocardial recording from an accessory atrioventricular pathway: localization of the site of block, effect of anti arrhythmic drugs and nonsurgical ablation. Circulation 1983; 68: 906–916.CrossRefGoogle ScholarPubMed
31.Winters, SL, Gomes, JS. Intracardiac catheter recording of atrioventricular bypass tracts in Wolff-Parkinson-White syndrome: techniques, electrophysiologic characteristics and demonstration of concealed and decremental propagation. J Am Coll Cardiol 1986; 7: 1392–1403.CrossRefGoogle ScholarPubMed