Value of the adenosine test for diagnosis of dual AV nodal physiology in patients with AV nodal reentrant tachycardia

摘要

Objectives:This study was aimed at assessing the value of the adenosine test for noninvasive diagnosis of dual AV nodal physiology(DAVNP) in patients with AV nodal reentrant tachycardia(VANRT).Methods:53 patients with paroxysmal supraventricular tachycardia(PSVT) were given incremental doses of adenosine intravenously during sinus rhythm before electrophysiological study.The adenosine test was repeated on a subset of 18 patients with AVNRT after radiofrequency catheter ablation.Results:Sudden increments of PR interval of more than 60 msec between two consecutive beats were observed in 26(83.9%) of 31 patients with typical AVNRT and 2(9.1%) of 22 patients with AVRT and AT(P<0.01),The maximal PR increment between 2 consecutive beats in the AVNRT group(105±45ms) was significantly greater than that in the AVRT and AT group[(20±13ms) (P<0.01),In postablation adenosine test,DAVNP was eliminated in all 8 patients who underwent slow pathway abolition that EPS showed the slow pathway disappeared and 4 of 10 patients who underwent slow pathway modification that EPS showed the slow pathway disappeared and 4 of 10 patients who underwent slow pathway modification that EPS whosed the slow pathway persisted.Six of 10 patients whw exhibited persistent duality showed a marked reduction in the number of beats conducted in the slow pathway after adenosine injection(P<0.01),COnclusions:Administration of adenosine during sinus rhythm may be a useful bedside test for diagnosis of DAVNP in high percentage of patients with typical AVNRT and additionally for evaluating the effects of radiofrequency ablation.