Electrophysiologic effects of adenosine-5'-triphosphate on atrioventricular reentrant tachycardia.

Abstract

The effects of adenosine-5'-triphosphate (ATP) on atrioventricular reentrant tachycardia (AVRT) were studied in 18 patients. Nine patients had AV nodal reentrant tachycardia and the remaining nine patients had AVRT with an accessory pathway for retrograde conduction. After electrophysiologic control study, ATP was administered (20 mg iv, rapid bolus) during sustained tachycardia and during right ventricular pacing (150 beats/min). ATP terminated the tachycardia within 16 sec of administration in eight of nine patients with AV nodal reentry and in all patients with accessory pathways. Termination of the tachycardia was related to a block in the antegrade slow pathway in patients with AV nodal reentry and to a block in the AV node in patients with accessory pathways. In one patient with AV nodal reentry, ATP resulted in a slowdown of the rate of the tachycardia due to delayed conduction in the slow antegrade pathway. No change in the conduction in the retrograde fast nodal pathway or in the accessory pathway was noted in any patient before termination of the tachycardia. The administration of ATP during ventricular pacing resulted in transient complete ventriculoatrial (VA) block or slight prolongation of VA conduction in five of nine patients with AV nodal reentry. VA conduction was not affected in four of nine patients with AV nodal reentry nor in all patients with accessory pathways. Short-lived and benign side effects were commonly noted after administration of ATP. Transient episodes of second-degree or complete AV block and sinus bradycardia were noted in eight patients and did not require any treatment. These results suggest that intravenous ATP is a safe and effective drug for rapid termination of AVRT. Circulation 68, No. 4, 827-833, 1983. FOR MANY YEARS adenosine-5'-triphosphate (ATP) has been successfully used in Europe to treat paroxysmal supraventricular tachycardia (PSVT) in adult patients. More recently ATP was established as a drug of first choice for quick termination of PSVT in infancy.6In spite of the wide clinical use of ATP, information on its electrophysiologic effects in patients with atrioventricular reentrant tachycardia (AVRT) is rather limited. In this study we assessed the efficacy and safety of ATP and evaluated its electrophysiologic mechanism of action in patients with AVRT. Material and methodsPatients.The criteria for patient selection were the following:(1) a history of documented recurrent PSVT, (2) inducible sustained AVRT during electrophysiologic study, and (3) no contraindication for the administration of ATP (asthma The study group consisted of 18 patients, six women and 12 men, ages 25 to 72 years (49 ± 14). Fifteen patients had no evidence of organic heart disease and three patients had coronary heart disease. In seven patients (Nos. 3,5,8,9,14,16,and 18) the tachycardias responded to vagal maneuvers, and in the remaining 11 patients pharmacologic intervention was required to terminate tachycardias.Electrophysiologic studies. Electrophysiologic studies were perfor...

Determination of Coronary Zero Flow Pressure by Analysis of the Baseline Pressure-Flow Relationship in Humans.

“…12, 13 Belardinelli et al showed that ATP (5 mole) was almost degraded completely in one passage through the isolated perfused guinea pig heart and that only 2.5% of the infused ATP was recovered in the effluent as ATP. 14 These findings are in agreement with previous reports showing that 97-99% of infused ATP is hydrolyzed during a single passage through the coronary vasculature.…”

Cardiac purinergic signalling in health and disease

“…Paroxysmal supraventricular tachycardia ATP was first used for the acute therapy of paroxysmal supraventricular tachycardia (PSVT) in the late 1940s [651] (and see reference to earlier studies therein) and later by others [652][653][654][655][656][657][658]. ATP was shown to evoke transient tachycardia at low doses and to induce AV block at high doses [659,660].…”

Treatment of Out‐of‐hospital Supraventricular Tachycardia: Adenosine vs Verapamil

“…The AHA recommendation for adenosine use is based on a number of factors, including its clinical use in all of the following clinical situations: 1) for all ages; 2) in hernodynamic instability, pregnancy, or preexcited SVT, 3) in wide-complex tachycardia, regardless of its arrhythmic origin; 4) in significant acute or chronic LV dysfunction; and 5) in the presence of other cardioactive medications. In each of these scenarios, verapamil would be either relatively or absolutely contraindicated.…”