Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2016 Jul;21(4):420-4.
doi: 10.1111/anec.12348. Epub 2016 Mar 10.

Adenosine and Preexcitation Variants: Reappraisal of Electrocardiographic Changes

Hussam Ali  1 , Pierpaolo Lupo  1 , Sara Foresti  1 , Guido De Ambroggi  1 , Gianluca Epicoco  1 , Angelica Fundaliotis  1 , Riccardo Cappato  2
Affiliations
Case Reports

Adenosine and Preexcitation Variants: Reappraisal of Electrocardiographic Changes

Hussam Ali et al. Ann Noninvasive Electrocardiol. 2016 Jul.

Abstract

Intravenous adenosine is a short-acting blocker of the atrioventricular node that has been used to unmask subtle or latent preexcitation, and also to enable catheter ablation in selected patients with absent or intermittent preexcitation. Depending on the accessory pathway characteristics, intravenous adenosine may produce specific electrocardiographic changes highly suggestive of the preexcitation variant. Herein, we view different ECG responses to this pharmacological test in various preexcitation patterns that were confirmed by electrophysiological studies. Careful analysis of electrocardiographic changes during adenosine test, with emphasis on P-delta interval, preexcitation degree, and atrioventricular block, can be helpful to diagnose the preexcitation variant/pattern.

Keywords: accessory pathway; adenosine; preexcitation variants.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) Twelve‐lead ECG and (B) intracardiac recordings during intravenous adenosine test in a patient with a left‐sided, Kent‐type AP (see text for discussion). CS = coronary sinus; d = distal; His = His bundle recording; p = proximal.
Figure 2
Figure 2
(A) Twelve‐lead ECG and (B) intracardiac recordings during intravenous adenosine test in a patient with a fasciculoventricular pathway (see text for discussion). Abbreviations are as in Figure 1.
Figure 3
Figure 3
(A) Twelve‐lead ECG and (B) intracardiac recordings during intravenous adenosine test in a patient with a nodoventricular pathway (see text for discussion). Abbreviations are as in Figure 1.
Figure 4
Figure 4
(Top) A simplified algorithm to interpret the electrocardiographic response to intravenous adenosine in various preexcitation patterns. (Bottom) A schematic design of the normal conduction system and various patterns of accessory pathways. The dotted areas indicate adenosine‐sensitive structures as the compact AV node and Mahaim accessory pathways. AF = atriofascicular; AFP = atriofascicular pathway; AV = atrioventricular; AVN = AV node; FVP = fasciculoventricular pathway; HB = His bundle; IV = intravenous; LBB = left bundle branch; NVP = nodoventricular pathway; RBB = right bundle branch.
See this image and copyright information in PMC

References

    1. Link MS. Evaluation and initial treatment of supraventricular tachycardia. N Engl J Med 2012;367:1438–1448. - PubMed
    1. Cohen TJ, Tucker KJ, Abbott JA, et al. Usefulness of adenosine in augmenting ventricular preexcitation for non‐invasive localization of accessory pathways. Am J Cardiol 1992;69:1178–1185. - PubMed
    1. Garratt CJ, Antoniou A, Griffith MJ, et al. Use of intravenous adenosine in sinus rhythm as a diagnostic test for latent preexcitation. Am J Cardiol 1990;65:868–873. - PubMed
    1. Lapage MJ, Walsh MJ, Reed JH, et al. Adenosine mapping for adenosine‐dependent accessory pathway ablation. Pacing Clin Electrophysiol 2014;37:610–615. - PubMed
    1. Papagiannis J, Vachtsevanos L, Rammos S, et al. Cryoablation of a nodoventricular Mahaim fiber. J Interv Card Electrophysiol 2005;14:111–116. - PubMed

Publication types

LinkOut - more resources