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Cited by 91Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlVagus Nerve Stimulation Research

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Adenosine: Potential modulator for vasovagal syncope

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Shen, Win-Kuang, Hammill, Stephen C., Munger, Thomas M., Stanton, Marshall S., Packer, Douglas L., Osborn, Michael J., Wood, Douglas L., Bailey, Kent R., Low, Phillip A., Gersh, Bernard J.·1996·Journal of the American College of Cardiology
DOI 10.1016/0735-1097(96)00100-3
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Abstract

Objectives This study examined the hypothesis that adenosine could provoke a vasovagal response in susceptible patients. Mechanisms of the vasovagal response were further explored by studying the adenosine-mediated reactions. Background Increased sympathetic activity is frequently observed before vasovagal syncope. Recent studies have demonstrated that adenosine, in addition to its direct bradycardiac and vasodilatory effects, can increase sympathetic discharge by activating cardiovascular afferent nerves. Methods The effects of adenosine and head-up tilt-table testing with or without isoproterenol were prospectively evaluated in 85 patients examined for syncope after negative results of electrophysiologic testing (51 men and 34 women, mean [+/- SD] age 61 +/- 17 years). Adenosine bolus injections of 6 mg and 12 mg were sequentially administered to patients in the upright position. The same protocol was implemented in 14 normal control subjects (7 men and 7 women, mean [+/- SD] age 38 +/- 10 years). Results Transient hypertension or tachycardia was observed in 57 (67%) and 20 (24%) patients after administration of 6 mg and 12 mg of adenosine, respectively, during the immediate phase (first 15 s), suggesting direct sympathetic activation. Hypotension and reflex tachycardia were observed in all patients during the delayed phase (15 to 60 s after adenosine injection), suggesting baroreceptor unloading. A vasovagal response was induced in 22 (26%) and 29 (34%) patients after adenosine administration and during tilt-table testing. Inducibility of a vasovagal response by these two methods was comparable (p = 0.12). Of the control subjects, one (7%) had a vasovagal response after adenosine administration and one (7%) had a positive response during tilt-table testing. Conclusions These observations support the idea that adenosine is an endogenous modulator of the cardiac excitatory afferent nerves. Sympathetic activation by adenosine can be direct (i.e., cardiac excitatory afferent nerves) and indirect (i.e., vasodilation and reflex sympathetic activation). Adenosine could be an important modulator in triggering a vasovagal response in susceptible patients during examination for syncope.

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  • High baseline levels of adenosine and further increases during syncope have been observed in patients with neurocardiogenic syncope.

    “Among the most interesting ones, high baseline levels of adenosine and further increases during syncope have been observed patients with neurocardiogenic syncope (Shen et al., 1996; Saadjian et al., 2002).”

    From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Shen et al., 1996

    The Methods (page not supplied) define baseline measurements as heart rate and blood pressure, then describe administering adenosine. The Results report responses to those injections, but our copy does not report baseline adenosine levels or measurements of adenosine during syncope (searched: plasma adenosine levels; endogenous adenosine concentration during syncope). (LLM, conf=0.78)

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Metadata

Authors
Shen, W.-K., Hammill, S. C., Munger, T. M., Stanton, M. S., Packer, D. L., Osborn, M. J., Wood, D. L., Bailey, K. R., Low, P. A., & Gersh, B. J.
Affiliations
Mayo Clinic (US)
Corresponding author
Shen, Win-Kuang
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
1996-07
Volume
28
Issue
1
Pages
146-154
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/0735-1097(96)00100-3
OpenAlex
W2091873768
Cited by
91
References
0
Citations by year
2025: 1 · 2024: 1 · 2022: 1 · 2020: 1 · 2019: 3 · 2018: 3 · 2017: 4 · 2015: 3 · 2014: 2 · 2013: 3 · 2012: 1
FWCI
5.26
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
Keywords
adenosine, vasovagal syncope, vasovagal reaction, sympathetic activation, baroreceptor unloading, tilt table test, isoproterenol, reflex tachycardia, hypotension, bradycardia
MeSH terms
Adenosine, Adult, Analysis of Variance, Blood Pressure, Electrocardiography, Female, Heart, Heart Rate, Humans, Isoproterenol, Male, Middle Aged, Prospective Studies, Sympathetic Nervous System, Syncope, Case-Control Studies, Tilt-Table Test

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