Circulation, Vol 90, 1832-1839, Copyright © 1994 by American Heart Association
WT Lai, CS Lee and SN Wu
BACKGROUND: The antiarrhythmic effects of sodium channel and calcium
channel blockers are known to be rate dependent. Little is known about the
rate-dependent effect of adenosine on human atrioventricular (AV) nodal
conduction. The purpose of this study was to determine whether the negative
dromotropic effect of adenosine is dependent on heart rate. METHODS AND
RESULTS: Atrial pacing at 20-millisecond increments decreasing stepwise was
performed, and the curves that relate the AH interval to the atrial pacing
cycle length were analyzed. The change in AV nodal function was evaluated
in three protocols: (1) In 8 group 1A and 6 group 1B patients, an
intravenous infusion of adenosine at a dose of 140 and 320
micrograms.kg-1.min-1 was given, respectively; (2) a bolus injection of a
fixed dose of adenosine was given to 12 group 2A patients without and 6
group 2B patients with propranolol (0.1 mg/kg) treatment; and (3) in 12
group 3 patients, the AV nodal function was evaluated after intravenous
propranolol (0.05 mg/kg) and after subsequent intravenous aminophylline
(loading dose, 5 mg/kg; maintenance dose, 0.9 mg.kg-1.h-1). No significant
depression of AV nodal function could be demonstrated during intravenous
infusion of adenosine. The bolus injection of adenosine could prolong the
AH interval, which was dependent on heart rate and more significant at a
shorter pacing cycle length. Intravenous propranolol significantly
depressed the AV nodal conduction and shifted the curves of the AH interval
versus the pacing cycle length to the right. Subsequent intravenous
aminophylline shortened the AV nodal conduction time, however, in a
rate-independent manner. CONCLUSIONS: The negative dromotropic effects
induced by intravenous bolus injection of adenosine became more pronounced
at fast atrial pacing rates. These results indicate that adenosine causes
rate-dependent prolongation of AV nodal conduction in humans.
ARTICLES
Rate-dependent properties of adenosine-induced negative dromotropism in humans
Department of Internal Medicine, Kaohsiung Medical College, Taiwan, Republic of China.
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