Impaired negative chronotropic response to adenosine in patients with inappropriate sinus tachycardia

Aino Maija Still, Heikki V. Huikuri, K. E Juhani Airaksinen, M. Juhani Koistinen, Raimo Kettunen, Juha Hartikainen, Raul Mitrani, Agustin Castellanos, Robert J Myerburg, M. J Pekka Raatikainen

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Abstract

Introduction: Adenosine is an endogenous nucleoside that has an important role in the diagnosis and treatment of several cardiac arrhythmias. However, its effects on inappropriate sinus tachycardia (IST) are not well established. Methods and Results: In this study, the response to intravenous adenosine (0.1 to 0.15 mg/kg) was studied in 18 patients (age 46 ± 15 years) with IST, In a subset of patients (n = 5), the direct effects of adenosine were assessed during pharmacologic beta-adrenergic and cholinergic blockade. Atrial cycle length (ACL) was measured before adenosine injection, at the time of the greatest cycle length prolongation, and during the maximum rebound acceleration of heart rate. Eighteen subjects (age 46 ± 11 years) with normal sinus rhythm undergoing clinically indicated electrophysiologic study served as controls. Adenosine did not terminate IST in any patient. The maximum dose of adenosine prolonged the sinus interval significantly, from 780 ± 128 msec to 985 ± 225 msec (P < 0.001) in the control subjects. In contrast, adenosine caused no significant lengthening of atrial cycle length (527 ± 69 msec vs 590 ± 148 msec; P = NS) in the patients with IST. Similar difference in the response to adenosine was seen during the pharmacologic autonomic blockade. The reflex increase of the sinus rate (rebound effect) was greater in the control subjects than in the patients with IST (21.2% ± 9.7% vs 8.5% ± 8.8%; P < 0.001). Conclusion: The usual negative chronotropic effect of adenosine was impaired in the patients with IST. This may have important diagnostic implications and provide new insight into the mechanism(s) of IST.

Original languageEnglish
Pages (from-to)557-562
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume13
Issue number6
StatePublished - Jun 20 2002

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Sinus Tachycardia
Adenosine
Nucleosides
Adrenergic Agents
Cholinergic Agents
Reflex
Cardiac Arrhythmias
Heart Rate

Keywords

  • Adenosine
  • Arrhythmia
  • Electrophysiology
  • Sinoatrial node
  • Tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Still, A. M., Huikuri, H. V., Airaksinen, K. E. J., Koistinen, M. J., Kettunen, R., Hartikainen, J., ... Raatikainen, M. J. P. (2002). Impaired negative chronotropic response to adenosine in patients with inappropriate sinus tachycardia. Journal of Cardiovascular Electrophysiology, 13(6), 557-562.

Impaired negative chronotropic response to adenosine in patients with inappropriate sinus tachycardia. / Still, Aino Maija; Huikuri, Heikki V.; Airaksinen, K. E Juhani; Koistinen, M. Juhani; Kettunen, Raimo; Hartikainen, Juha; Mitrani, Raul; Castellanos, Agustin; Myerburg, Robert J; Raatikainen, M. J Pekka.

In: Journal of Cardiovascular Electrophysiology, Vol. 13, No. 6, 20.06.2002, p. 557-562.

Research output: Contribution to journalArticle

Still, AM, Huikuri, HV, Airaksinen, KEJ, Koistinen, MJ, Kettunen, R, Hartikainen, J, Mitrani, R, Castellanos, A, Myerburg, RJ & Raatikainen, MJP 2002, 'Impaired negative chronotropic response to adenosine in patients with inappropriate sinus tachycardia', Journal of Cardiovascular Electrophysiology, vol. 13, no. 6, pp. 557-562.
Still AM, Huikuri HV, Airaksinen KEJ, Koistinen MJ, Kettunen R, Hartikainen J et al. Impaired negative chronotropic response to adenosine in patients with inappropriate sinus tachycardia. Journal of Cardiovascular Electrophysiology. 2002 Jun 20;13(6):557-562.
Still, Aino Maija ; Huikuri, Heikki V. ; Airaksinen, K. E Juhani ; Koistinen, M. Juhani ; Kettunen, Raimo ; Hartikainen, Juha ; Mitrani, Raul ; Castellanos, Agustin ; Myerburg, Robert J ; Raatikainen, M. J Pekka. / Impaired negative chronotropic response to adenosine in patients with inappropriate sinus tachycardia. In: Journal of Cardiovascular Electrophysiology. 2002 ; Vol. 13, No. 6. pp. 557-562.
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abstract = "Introduction: Adenosine is an endogenous nucleoside that has an important role in the diagnosis and treatment of several cardiac arrhythmias. However, its effects on inappropriate sinus tachycardia (IST) are not well established. Methods and Results: In this study, the response to intravenous adenosine (0.1 to 0.15 mg/kg) was studied in 18 patients (age 46 ± 15 years) with IST, In a subset of patients (n = 5), the direct effects of adenosine were assessed during pharmacologic beta-adrenergic and cholinergic blockade. Atrial cycle length (ACL) was measured before adenosine injection, at the time of the greatest cycle length prolongation, and during the maximum rebound acceleration of heart rate. Eighteen subjects (age 46 ± 11 years) with normal sinus rhythm undergoing clinically indicated electrophysiologic study served as controls. Adenosine did not terminate IST in any patient. The maximum dose of adenosine prolonged the sinus interval significantly, from 780 ± 128 msec to 985 ± 225 msec (P < 0.001) in the control subjects. In contrast, adenosine caused no significant lengthening of atrial cycle length (527 ± 69 msec vs 590 ± 148 msec; P = NS) in the patients with IST. Similar difference in the response to adenosine was seen during the pharmacologic autonomic blockade. The reflex increase of the sinus rate (rebound effect) was greater in the control subjects than in the patients with IST (21.2{\%} ± 9.7{\%} vs 8.5{\%} ± 8.8{\%}; P < 0.001). Conclusion: The usual negative chronotropic effect of adenosine was impaired in the patients with IST. This may have important diagnostic implications and provide new insight into the mechanism(s) of IST.",
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AU - Still, Aino Maija

AU - Huikuri, Heikki V.

AU - Airaksinen, K. E Juhani

AU - Koistinen, M. Juhani

AU - Kettunen, Raimo

AU - Hartikainen, Juha

AU - Mitrani, Raul

AU - Castellanos, Agustin

AU - Myerburg, Robert J

AU - Raatikainen, M. J Pekka

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N2 - Introduction: Adenosine is an endogenous nucleoside that has an important role in the diagnosis and treatment of several cardiac arrhythmias. However, its effects on inappropriate sinus tachycardia (IST) are not well established. Methods and Results: In this study, the response to intravenous adenosine (0.1 to 0.15 mg/kg) was studied in 18 patients (age 46 ± 15 years) with IST, In a subset of patients (n = 5), the direct effects of adenosine were assessed during pharmacologic beta-adrenergic and cholinergic blockade. Atrial cycle length (ACL) was measured before adenosine injection, at the time of the greatest cycle length prolongation, and during the maximum rebound acceleration of heart rate. Eighteen subjects (age 46 ± 11 years) with normal sinus rhythm undergoing clinically indicated electrophysiologic study served as controls. Adenosine did not terminate IST in any patient. The maximum dose of adenosine prolonged the sinus interval significantly, from 780 ± 128 msec to 985 ± 225 msec (P < 0.001) in the control subjects. In contrast, adenosine caused no significant lengthening of atrial cycle length (527 ± 69 msec vs 590 ± 148 msec; P = NS) in the patients with IST. Similar difference in the response to adenosine was seen during the pharmacologic autonomic blockade. The reflex increase of the sinus rate (rebound effect) was greater in the control subjects than in the patients with IST (21.2% ± 9.7% vs 8.5% ± 8.8%; P < 0.001). Conclusion: The usual negative chronotropic effect of adenosine was impaired in the patients with IST. This may have important diagnostic implications and provide new insight into the mechanism(s) of IST.

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KW - Electrophysiology

KW - Sinoatrial node

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