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Mechanism-Specific Effects of Adenosine on Ventricular Tachycardia.
MedLine Citation:
PMID:  25132104     Owner:  NLM     Status:  Publisher    
INTRODUCTION: There is no universally accepted method by which to diagnose clinical ventricular tachycardia (VT) due to cAMP-mediated triggered activity. Based on cellular and clinical data, adenosine termination of VT is thought to be consistent with a diagnosis of triggered activity. However, a major gap in evidence mitigates the validity of this proposal, namely, defining the specificity of adenosine response in well-delineated reentrant VT circuits. To this end, we systematically studied the effects of adenosine in a model of canine reentrant VT and in human reentrant VT, confirmed by 3-dimensional, pace- and substrate- mapping.
METHODS AND RESULTS: Adenosine (12 mg [IQR 12-24]) failed to terminate VT in 31/31 patients with reentrant VT due to structural heart disease, and had no effect on VT cycle length (age, 67 years [IQR 53-74]); ejection fraction, 35% [IQR 20-55]). In contrast, adenosine terminated VT in 45/50 (90%) patients with sustained focal right or left outflow tract tachycardia. The sensitivity of adenosine for identifying VT due to triggered activity was 90% (95% CI, .78-.97) and its specificity was 100% (95% CI, .89-1.0). Additionally, reentrant circuits were mapped in the epicardial border zone of 4-day-old infarcts in mongrel dogs. Adenosine (300-400 μg/kg) did not terminate sustained VT or have any effect on VT cycle length.
CONCLUSION: These data support the concept that adenosine's effects on ventricular myocardium are mechanism-specific, such that termination of VT in response to adenosine is diagnostic of cAMP-mediated triggered activity. This article is protected by copyright. All rights reserved.
Bruce B Lerman; James E Ip; Bindi K Shah; George Thomas; Christopher F Liu; Edward J Ciaccio; Andrew L Wit; Jim W Cheung; Steven M Markowitz
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-8-6
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-8-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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