Electrophysiologic Effects of Intravenous Adenosine Triphosphate Disodium on the Paroxysmal Supraventricular Tachycardias

• Published in: Japanese Heart Journal Vol. 26; no. 1; pp. 33 - 43
• Main Authors: TAJIMA, Tsunemi, MURAMATSU, Toshihiro, KANAKA, Shinichiro, YANAGISHITA, Yoshiki, IDE, Masao, DOHI, Yutaka
• Format: Journal Article
• Language: English
• Published: Tokyo International Heart Journal Association 1985; Japanese Heart Journal Association
• Subjects: Adenosine Triphosphate - administration & dosage; Adenosine Triphosphate - pharmacology; Adult; Aged; Antiarythmic agents; ATP-2Na potentiation by inosine; Atrioventricular Node - drug effects; Atrioventricular Node - physiopathology; Biological and medical sciences; Cardiovascular system; Drug Synergism; Electrophysiologic effects; Electrophysiology; Female; Heart Conduction System - drug effects; Heart Conduction System - physiopathology; Humans; Injections, Intravenous; Inosine - administration & dosage; Inosine - pharmacology; Male; Medical sciences; Middle Aged; Paroxysmal supraventricular tachycardias; Pharmacology. Drug treatments; Refractory Period, Electrophysiological - drug effects; Sinoatrial Node - drug effects; Sinoatrial Node - physiopathology; Tachycardia, Paroxysmal - physiopathology; Ventricular pacing; Wolff-Parkinson-White Syndrome - physiopathology; Human; Electrophysiology; Intravenous administration; Paroxysmal supraventricular tachycardia; Arrhythmia; Biological activity
• ISSN: 0021-4868; 1348-673X
• DOI: 10.1536/ihj.26.33

We studied the electrophysiologic effects of intravenous adenosine triphosphate disodium (ATP-2Na) on 15 patients with paroxysmal supraventricular tachycardias (PSVTs). One patient had sinus node (SN) reentry and 2 patients had intraatrial (IA) reentry. Five patients had AV nodal reentry and 7 patients had atrioventricular reentrant tachycardias (AVRTs) with accessory pathways (APs). ATP-2Na was injected during ventricular pacing (VP) in patients with AVRTs with APs. A bolus injection of ATP-2Na terminated all the PSVTs within 40 sec except in one case of IA reentry. The sites of block at the termination were the atrium in SN reentry and IA reentry, between A and H (AH) block or between H and A (HA) block in AV nodal reentry and AH block in all the AVRTs with APs. ATP-2Na during VP in patients with AVRTs with APs produced the changes of atrial activation sequences in 3 patients, induction of PSVT in 2 patients and a Mobitz type II VA block in 2 patients. The former two phenomena suggested a retrograde AV nodal block and raised the possibility of a simple test for retrograde atrial fusion during VP in patients with WPW syndrome. Chest discomfort of short duration was most commonly noted after ATP-2Na. Inosine pretreatment potentiated the effects of ATP-2Na. This combination may further alleviate the side effects of ATP-2Na, while preserving the effective action of ATP-2Na for rapid termination of PSVTs.