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Cited by 88Cardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmiasAtrial Fibrillation Management and Outcomes

Differential effects of adenosine on focal and macroreentrant atrial tachycardia

MARKOWITZ, STEVEN M., STEIN, KENNETH M., MITTAL, SUNEET, SLOTWTNER, DAVID J., LERMAN, BRUCE B.·1999·Journal of Cardiovascular Electrophysiology
DOI 10.1111/j.1540-8167.1999.tb00705.x
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Abstract

INTRODUCTION: The effects of adenosine on atrial tachycardia (AT) remain controversial, and the mechanistic implications of adenosine termination have not been fully established. The purpose of this study was to elucidate the differential effects of adenosine on focal and macroreentrant AT and describe the characteristics of adenosine-sensitive AT. METHODS AND RESULTS: Thirty patients received adenosine during AT. Tachycardia origins were identified as focal or macroreentrant during invasive electrophysiologic studies. Responses to adenosine were analyzed and characterized as tachycardia termination, transient suppression, or no effect. Electrophysiologic studies demonstrated a focal origin of tachycardia in 17 patients. Adenosine terminated focal tachycardias in 14 patients (dose 7.3 +/- 4.0 mg) and transiently suppressed the arrhythmias in three others (dose 10.0 +/- 6.9 mg). A macroreentrant mechanism was demonstrated in 13 patients; adenosine terminated only one of these tachycardias and had no effect on the remaining 12 patients (dose 10.2 +/- 2.9 mg). Four classes of adenosine-sensitive AT were identified. Class I consisted of nine patients with tachycardia arising from the crista terminalis; these tachycardias also terminated with verapamil (4/4). Class II consisted of four patients with repetitive monomorphic AT arising from diverse sites in the right atrium; these either slowed or terminated in response to verapamil (2/2). Class III consisted of the three patients with transient suppression and demonstrated electropharmacologic characteristics consistent with an automatic mechanism, including insensitivity to verapamil (2/2). In the one patient with macroreentrant AT that was comprised of decremental atrial tissue, adenosine terminated tachycardia in a zone of decremental slow conduction (Class IV); this tachycardia slowed with verapamil. CONCLUSIONS: Adenosine-sensitive AT is usually focal in origin and arises either from the region of the crista terminalis (inclusive of the sinus node) or from diverse atrial sites with an incessant nonsustained repetitive pattern. Although most forms of macroreentrant AT are insensitive to adenosine, rarely macroreentrant AT with zones of decremental slow conduction can demonstrate adenosine sensitivity.

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Crossref · 10.1111/j.1540-8167.1999.tb00705.x

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Authors
MARKOWITZ, S. M., STEIN, K. M., MITTAL, S., SLOTWTNER, D. J., & LERMAN, B. B.
Affiliations
Cornell University (US)
Corresponding author
LERMAN, BRUCE B.
ORCID
Venue
Journal of Cardiovascular Electrophysiology
Publisher
Wiley
Published
1999-04
Volume
10
Issue
4
Pages
489-502
ISSN
  • 1045-3873 (ISSN-L)
  • 1540-8167
DOI
10.1111/j.1540-8167.1999.tb00705.x
OpenAlex
W2104919530
Cited by
88
References
37
Citations by year
2026: 2 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 5 · 2018: 3 · 2017: 3 · 2016: 3 · 2015: 7 · 2014: 2 · 2013: 1 · 2012: 2
FWCI
1.70
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 2941 d)
Locations
  • Journal of Cardiovascular Electrophysiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
U.S. Public Health Service (R01 56139)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Keywords
adenosine, atrial tachycardia, focal atrial tachycardia, macroreentrant atrial tachycardia, tachycardia termination, transient suppression, crista terminalis, verapamil, right atrium
MeSH terms
Adenosine, Adolescent, Adult, Aged, Anti-Arrhythmia Agents, Cardiotonic Agents, Catheterization, Central Venous, Electrophysiology, Female, Cardiac Catheterization, Heart Rate, Humans, Injections, Intravenous, Isoproterenol, Male, Middle Aged, Tachycardia, Atrioventricular Nodal Reentry, Verapamil, Treatment Outcome

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