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The intravenous adenosine test: a new test for the identification of bradycardia pacing indications? A pilot study in subjects with bradycardia pacing indications, vasovagal syncope and controls

Lookup NU author(s): Dr Steve Parry, Dr Thomas Chadwick, Dr Janine Gray, Dr Rodney Bexton, Dr John Bourke

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Abstract

Design: Pilot cohort study. Methods: Patients-(i) Bradycardia-pacing group: Consecutive patients referred for pacing for SND, AVB and CSS; (ii) Consecutive head-up tilt (HUT)-positive VVS patients. Controls-(i) Simple controls (S-Con: normal examination/ECG) and (ii) Electrophysiology controls (EP-Con: consecutive subjects referred for accessory pathway ablation). Pacing referrals and EP-Con had electrophysiology studies to confirm referral diagnosis and exclude others. All subjects had bolus injection of 20 mg intravenous adenosine during continuous ECG and blood pressure monitoring (positive test: >= 6 s asystole, >= 10 s high-degree AVB post-injection). Sensitivity, specificity, safety and tolerability of the test were measured. Results: Of 264 potential participants (4 SND, 8 AVB, 7 CSS, 10 VVS, 10 EP-Con and 11 S-Con) 50 were studied. All (100%) of the bradycardia-pacing group were adenosine test-positive, as were 6 (60%) VVS. None (0%) and 3 (27%) of the EP- and S-Con groups were positive. Adenosine testing was 100% sensitive and 86% specific for bradycardia-pacing indications, and 100% specific using the diagnostically 'clean' EP-Con results. There were no significant adverse or side effects. Conclusions: Adenosine testing reliably identified patients with definitive bradycardia-pacing indications in whom alternative diagnoses were excluded. Further work is needed to evaluate the role of this test in the diagnosis of unexplained syncope.


Publication metadata

Author(s): Parry SW, Chadwick T, Gray JC, Bexton RS, Tynan M, Bourke JP, Nath S

Publication type: Article

Publication status: Published

Journal: QJM

Year: 2009

Volume: 102

Issue: 7

Pages: 461-468

ISSN (print): 1460-2725

ISSN (electronic): 1460-2393

Publisher: Oxford University Press

URL: http://dx.doi.org/10.1093/qjmed/hcp048

DOI: 10.1093/qjmed/hcp048


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