Use of intravenous adenosine in sinus rhythm as a diagnostic test for latent preexcitation

Garratt, Clifford J.; Antoniou, Anna; Griffith, Michael; Ward, David; Camm, A. John

doi:10.1016/0002-9149(90)91428-9

Cited by 80 publications

(32 citation statements)

References 22 publications

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“…This is caused by the blocking of the AV node allowing conduction through the accessory pathway, thus unmasking the accessory pathway conduction. Garratt and colleagues 13 described the use of intravenous adenosine to unmask latent pre-excitation during sinus rhythm.…”

Section: Discussionmentioning

confidence: 99%

Adenosine induced PR jump on surface ECG to differentiate atrioventricular nodal re-entrant tachycardia from concealed accessory pathway mediated tachycardia: a bedside test

Toal

Vajifdar²,

Gupta³

et al. 2002

Heart

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Objective: To evaluate the efficacy of single dose intravenous adenosine in differentiating atrioventricular nodal re-entrant tachycardia (AVNRT) from concealed pathway mediated atrioventricular re-entrant tachycardia (AVRT) using surface ECG at the bedside. Method: 12 mg of adenosine was administered to 97 consecutive patients who had documented narrow QRS tachycardia without manifest pre-excitation. The test was labelled positive for AVNRT if surface ECG recordings showed signs of dual atrioventricular (AV) node physiology-namely, PR jump or AV nodal echo. The diagnostic value of this test was evaluated by electrophysiological study as the yardstick.Results: The adenosine test was positive for AVNRT in 48 patients (adenosine induced PR jump in 48, AV nodal echo in 3) and negative in 49 patients. On electrophysiological study, 62 patients had AVNRT and 35 had concealed pathway mediated AVRT. Thus, the test had a sensitivity of 74% and specificity of 94%. The positive predictive value was 96% and the negative predictive value was 67%. Conclusion: Single dose (12 mg) intravenous adenosine administered during sinus rhythm can identify dual AV node physiology on surface ECG recording at the bedside. A positive adenosine test identified by a PR jump can differentiate AVNRT from AVRT with a high specificity and positive predictive accuracy.

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Section: Discussionmentioning

confidence: 99%

Adenosine induced PR jump on surface ECG to differentiate atrioventricular nodal re-entrant tachycardia from concealed accessory pathway mediated tachycardia: a bedside test

Toal

Vajifdar²,

Gupta³

et al. 2002

Heart

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“…Sensitivity and specificity have been cited as 100% among patients in whom adenosine produces AV nodal conduction delay or block. The remainder may require invasive electrophysiological studies to exclude latent pre-excitation [56]. …”

Section: Supplementary Investigationsmentioning

confidence: 99%

Sudden Cardiac Death in the Young: A Strategy for Prevention by Targeted Evaluation

Sen‐Chowdhry

McKenna

2006

Cardiology

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The annual incidence of sudden cardiac death (SCD) in the general population is estimated as 1 in a 1,000. Since survival rates from out-of-hospital cardiac arrests are poor, primary prevention is key to reducing the burden of SCD in the community. Prominent causes of SCD include ischaemic heart disease, anomalous coronary arteries, and the primary myocardial diseases: hypertrophic cardiomyopathy, dilated cardiomyopathy, and ar rhythmogenic right ventricular cardiomyopathy (ARVC). In 4% of sudden deaths in the 16–64 age group, post-mortem examination fails to identify a cause, yielding a default diagnosis of sudden arrhythmic death syndrome (SADS). The inherited arrhythmia syndromes (long QT, short QT, and Brugada syndromes, and familial catecholaminergic polymorphic ventricular tachycardia) may be implicated in SADS, owing to their propensity for producing ventricular tachyarrhythmia in the structurally normal heart. Monogenic disorders therefore predominate as causes of SCD in the young. The advent of effective therapies for these diseases, particularly implantable cardioverter defibrillators, has prompted calls for universal screening to enable timely diagnosis of occult cardiac disease. Since prospective cardiac assessment of the general population is not feasible, the solution may be to target high-risk subgroups, namely, patients with cardiac symptoms, relatives of SCD victims, and competitive athletes. The recommended preliminary work-up includes a 12-lead ECG, signal-averaged ECG, transthoracic echocardiogram, exercise test, and ambulatory ECG monitoring. Cardiovascular magnetic resonance is a useful adjunct in patients with suspected ARVC or anomalous coronary arteries. Provocative challenge with a sodium challenge blocker may be of value in unmasking the Brugada syndrome. Identification of disease-causing mutations in affected individuals facilitates cascade screening of families.

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“…forced to conduct predominantly through the accessory pathway by blocking conduction over the AV node with intravenous adenosine or verapamil. 3,4 PR intervals remain relatively unchanged, QRS complexes become broader, and pseudoinfarction Q waves may become prominent. However, in our case we did not need any pharmacologic interventions because on a few consecutive ECGs delta waves disappeared and reappeared subsequently.…”

Section: Discussionmentioning

confidence: 99%

Intermittent delta waves mimicking inferior myocardial infarction

Yontar¹,

Tenekecioğlu²,

Karaagac³

et al. 2014

Asian J Med Sci

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Use of intravenous adenosine in sinus rhythm as a diagnostic test for latent preexcitation

Cited by 80 publications

References 22 publications

Adenosine induced PR jump on surface ECG to differentiate atrioventricular nodal re-entrant tachycardia from concealed accessory pathway mediated tachycardia: a bedside test

Adenosine induced PR jump on surface ECG to differentiate atrioventricular nodal re-entrant tachycardia from concealed accessory pathway mediated tachycardia: a bedside test

Sudden Cardiac Death in the Young: A Strategy for Prevention by Targeted Evaluation

Intermittent delta waves mimicking inferior myocardial infarction

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