USE OF INTRAVENOUS ADENOSINE IN SINUS RHYTHM AS A DIAGNOSTIC-TEST FOR LATENT PREEXCITATION

被引:67
作者
GARRATT, CJ [1 ]
ANTONIOU, A [1 ]
GRIFFITH, MJ [1 ]
WARD, DE [1 ]
CAMM, AJ [1 ]
机构
[1] ST GEORGE HOSP,SCH MED,DEPT CARDIOL SCI,CRANMER TERRACE,LONDON SW17 0RE,ENGLAND
关键词
D O I
10.1016/0002-9149(90)91428-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In a proportion of patients with left free wall accessory connections, preexcitation is apparent only during atrial arrhythmias or atrial pacing (latent preexcitation). These patients may be at risk of a rapid ventricular response to atrial fibrillation despite the absence of preexcitation in sinus rhythm. The ability of intravenous adenosine to unmask latent preexcitation was evaluated in 22 patients with a history of documented supraventricular tachycardia and a normal electrocardiogram during sinus rhythm. Preexcitation was unmasked in response to adenosine in 4 patients: all 4 were shown to have latent preexcitation at electrophysiologic study. In 12 patients atrioventricular (AV) nodal conduction delay or block was induced without preexcitation after adenosine (first-degree AV block in 8, second-degree block in 4): at subsequent electrophysiologic study none of these patients was found to have latent preexcitation. Five patients had little or no PR prolongation in response to adenosine: of these, 2 were shown to have latent preexcitation at electrophysiologic study. Atrial fibrillation was induced in 1 patient and a narrow complex regular tachycardia in another after intravenous adenosine. Intravenous adenosine during sinus rhythm is capable of producing AV nodal conduction delay or block in 73% of patients with a history of supraventricular tachycardia: in these patients adenosine provides a diagnostic test that is both 100% sensitive and 100% specific for latent preexcitation. In those patients in whom adenosine does not produce AV conduction delay or block, further investigation is required to establish or refute the diagnosis of latent preexcitation. © 1990.
引用
收藏
页码:868 / 873
页数:6
相关论文
共 28 条
[1]   ISOLATED ATRIAL MYOCYTES - ADENOSINE AND ACETYLCHOLINE INCREASE POTASSIUM CONDUCTANCE [J].
BELARDINELLI, L ;
ISENBERG, G .
AMERICAN JOURNAL OF PHYSIOLOGY, 1983, 244 (05) :H734-H737
[2]   ATRIAL-FIBRILLATION INDUCED BY ADENOSINE-TRIPHOSPHATE [J].
BELHASSEN, B ;
PELLEG, A ;
SHOSHANI, D ;
LANIADO, S .
AMERICAN JOURNAL OF CARDIOLOGY, 1984, 53 (09) :1405-1406
[3]   BASIS OF STATIC AND DYNAMIC ELECTROCARDIOGRAPHIC VARIATIONS IN WOLFF-PARKINSON-WHITE SYNDROME - ANATOMIC AND ELECTROPHYSIOLOGIC OBSERVATIONS IN RIGHT AND LEFT VENTRICULAR PREEXCITATION [J].
BOINEAU, JP ;
MOORE, EN ;
SPEAR, JF ;
SEALY, WC .
AMERICAN JOURNAL OF CARDIOLOGY, 1973, 32 (01) :32-45
[4]   RAPID AUTONOMIC TONE REGULATION OF ATRIOVENTRICULAR NODAL CONDUCTION IN MAN [J].
BUTROUS, GS ;
COCHRANE, T ;
CAMM, AJ .
AMERICAN HEART JOURNAL, 1987, 113 (04) :934-940
[5]   EVALUATION OF NONINVASIVE TESTS FOR IDENTIFYING PATIENTS WITH PREEXCITATION SYNDROME AT RISK OF RAPID VENTRICULAR RESPONSE [J].
CRITELLI, G ;
GALLAGHER, JJ ;
PERTICONE, F ;
COLTORTI, F ;
MONDA, V ;
CONDORELLI, M .
AMERICAN HEART JOURNAL, 1984, 108 (04) :905-909
[6]   ANATOMIC AND ELECTROPHYSIOLOGIC SUBSTRATE OF THE PERMANENT FORM OF JUNCTIONAL RECIPROCATING TACHYCARDIA [J].
CRITELLI, G ;
GALLAGHER, JJ ;
MONDA, V ;
COLTORTI, F ;
SCHERILLO, M ;
ROSSI, L .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1984, 4 (03) :601-610
[7]   ADENOSINE - ELECTROPHYSIOLOGIC EFFECTS AND THERAPEUTIC USE FOR TERMINATING PAROXYSMAL SUPRA-VENTRICULAR TACHYCARDIA [J].
DIMARCO, JP ;
SELLERS, TD ;
BERNE, RM ;
WEST, GA ;
BELARDINELLI, L .
CIRCULATION, 1983, 68 (06) :1254-1263
[8]   ELECTROPHYSIOLOGIC CHARACTERISTICS OF CONCEALED BYPASS TRACTS - CLINICAL AND ELECTROCARDIOGRAPHIC CORRELATES [J].
FARSHIDI, A ;
JOSEPHSON, ME ;
HOROWITZ, LN .
AMERICAN JOURNAL OF CARDIOLOGY, 1978, 41 (06) :1052-1060
[9]   MULTIPLE ACCESSORY PATHWAYS IN PATIENTS WITH PRE-EXCITATION SYNDROME [J].
GALLAGHER, JJ ;
SEALY, WC ;
KASELL, J ;
WALLACE, AG .
CIRCULATION, 1976, 54 (04) :571-591
[10]   PREEXCITATION SYNDROMES [J].
GALLAGHER, JJ ;
PRITCHETT, ELC ;
SEALY, WC ;
KASELL, J ;
WALLACE, AG .
PROGRESS IN CARDIOVASCULAR DISEASES, 1978, 20 (04) :285-327