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- Title
Mechanism-Specific Effects of Adenosine on Ventricular Tachycardia.
- Authors
LERMAN, BRUCE B.; IP, JAMES E.; SHAH, BINDI K.; THOMAS, GEORGE; LIU, CHRISTOPHER F.; CIACCIO, EDWARD J.; WIT, ANDREW L.; CHEUNG, JIM W.; MARKOWITZ, STEVEN M.
- Abstract
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 of 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 of 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, 0.78-0.97) and its specificity was 100% (95% CI, 0.89-1.0). 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.
- Subjects
ADENOSINES; ANIMAL experimentation; BODY surface mapping; CHI-squared test; CONFIDENCE intervals; DOGS; ELECTROPHYSIOLOGY; FISHER exact test; RESEARCH funding; VENTRICULAR tachycardia; DATA analysis software; DESCRIPTIVE statistics; MANN Whitney U Test; THERAPEUTICS
- Publication
Journal of Cardiovascular Electrophysiology, 2014, Vol 25, Issue 12, p1350
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.12510