Persistent second-degree atrioventricular block following adenosine infusion for nuclear stress testing

Makaryus, John N.; Catanzaro, John N.; Friedman, Michael; Katona, Kyle C.; Makaryus, Amgad N.

doi:10.2459/jcm.0b013e3282785288

Cited by 13 publications

(18 citation statements)

References 10 publications

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“…We propose asynchronous pacing in AV block because the risk of asystole under adenosine is high [ 35 ], persistent AV-block after cessation of adenosine infusion has been described [ 36 ]. HR remained constant because AV conduction was impaired and increase in sinus rate due to sympathetic stimulation did not translate into tachycardia making competitive pacing unlikely.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of adenosine cardiovascular magnetic resonance in patients with MR conditional pacemaker systems at 1.5 Tesla

Klein-Wiele

Garmer

Urbien

et al. 2015

Journal of Cardiovascular Magnetic Resonance

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BackgroundCardiovascular Magnetic Resonance (CMR) with adenosine stress is a valuable diagnostic tool in coronary artery disease (CAD). However, despite the development of MR conditional pacemakers CMR is not yet established in clinical routine for pacemaker patients with known or suspected CAD. A possible reason is that adenosine stress perfusion for ischemia detection in CMR has not been studied in patients with cardiac conduction disease requiring pacemaker therapy. Other than under resting conditions it is unclear whether MR safe pacing modes (paused pacing or asynchronous mode) can be applied safely because the effect of adenosine on heart rate is not precisely known in this entity of patients. We investigate for the first time feasibility and safety of adenosine stress CMR in pacemaker patients in clinical routine and evaluate a pacing protocol that considers heart rate changes under adenosine.MethodsWe retrospectively analyzed CMR scans of 24 consecutive patients with MR conditional pacemakers (mean age 72.1 ± 11.0 years) who underwent CMR in clinical routine for the evaluation of known or suspected CAD. MR protocol included cine imaging, adenosine stress perfusion and late gadolinium enhancement.ResultsPacemaker indications were sinus node dysfunction (n = 18) and second or third degree AV block (n = 6). Under a pacing protocol intended to avoid competitive pacing on the one hand and bradycardia due to AV block on the other no arrhythmia occurred. Pacemaker stimulation was paused to prevent competitive pacing in sinus node dysfunction with resting heart rate >45 bpm. Sympatho-excitatory effect of adenosine led to a significant acceleration of heart rate by 12.3 ± 8.3 bpm (p < 0.001), no bradycardia occurred. On the contrary in AV block heart rate remained constant; asynchronous pacing above resting heart rate did not interfere with intrinsic rhythm.ConclusionAdenosine stress CMR appears to be feasible and safe in patients with MR conditional pacemakers. Heart rate response to adenosine has to be considered for the choice of pacing modes during CMR.

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Section: Discussionmentioning

confidence: 99%

Feasibility and safety of adenosine cardiovascular magnetic resonance in patients with MR conditional pacemaker systems at 1.5 Tesla

Klein-Wiele

Garmer

Urbien

et al. 2015

Journal of Cardiovascular Magnetic Resonance

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“…15 Adenosine binds to cardiac A1 receptors, which initiates a cascade through activation of adenyl cyclase, decreasing intracellular cyclic adenosine monophosphate (cAMP), which results in decreased inward calcium conductance. 16 This results in depressed sinoatrial (SA) node activity (negative chronotropic effect), slowed atrioventricular (AV) nodal conduction (negative dromotropic effect), and decreased atrial contractility and ventricular automaticity. 17 The clinical effect is seen 10 to 20 seconds after bolus injection of adenosine, leading to AV nodal blockade, bradycardia, sinus pauses, and cardiac arrest; all of this causes a decrease in cardiac output and mean arterial pressure (MAP).…”

Section: Adenosinementioning

confidence: 99%

“…20,21 Chronic smokers without the presence of severe reactive airway disease do not pose any risk of bronchospasm with adenosine. 33 Another situation in which one needs to be cautious with adenosine use was pointed out by a study by Makaryus et al, 16 which reported development of a persistent AV block in patients with pre-existing right bundle branch block, when large doses of adenosine (47 mg over 5 minutes) were used and required postoperative permanent pacemaker implantation. Adenosine action on the coronary vasculature causes vasodilation, and this results in coronary vascular steal phenomenon in patients with cardiac ischemia.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

Adenosine-Assisted Management of Intracranial Aneurysm

Thakore

Goraksha

Monteiro

2019

Journal of Neuroanaesthesiology and Critical Care

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Cerebral aneurysms can be complex and variable in size, position, and morphology, resulting in difficult surgical exposure and secure clip placement. They have a high mortality rate when ruptured, and though endovascular techniques have emerged to tackle this, surgical clip ligation remains the preferred modality for some aneurysms. Various techniques that help the surgeon dissect the aneurysmal dome and apply the clip are temporary clip ligation of proximal vessels, deep hypothermic circulatory arrest, and balloon suction decompression. All of them require significant logistics and result in increased morbidity and mortality. Adenosine is a suitable alternative for inducing a temporary flow arrest, causing a short period of controlled hypotension. Its rapid onset and offset property along with low incidence of adverse events makes it an ideal agent in this regard. We present here a review on its use, contraindications, safety profile, and future applications.

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“…In the Adenoscan multicenter trial registry, it was found that 706 out 9,250 patients (7.6 %) undergoing stress testing with adenosine developed transient atrio-ventricular (AV) conduction block [22]. Makaryus et al [23] reported the development of a persistent AV block in patients with pre-existing right bundle branch block after large doses of adenosine (47 mg over 5 min). Therefore, in our opinion anesthesiologists should be cautious about using adenosine in patients with pre-existing conduction defects.…”

Section: Precautionsmentioning

confidence: 99%

The Use of Adenosine in Cerebral Aneurysm Clipping: A Review

Khan

Nimjee

Guinn

et al. 2013

Curr Anesthesiol Rep

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Management of intracranial aneurysms continues to evolve, with coiling of aneurysms becoming an increasingly used modality. However, for aneurysms which are considered to be ''complex'' due to their size, position, or morphology, clipping continues to be the preferred treatment option. Several techniques can be utilized intraoperatively to facilitate aneurysm exposure and clip ligation. These include deep hypothermic circulatory arrest, endovascular balloon occlusion with suction, and, most commonly, temporary clip application to the proximal feeding vessel. The use of these techniques has been limited by the associated significant morbidity and mortality, and in the case of temporary clipping, anatomic limitations preventing clip application in certain cases. Recently, adenosine induced transient circulatory arrest has undergone a resurgence in neurosurgical practice to assist in complex aneurysm clip ligation. In this article we review this technique with special emphasis on appropriate patient selection and safety profile.

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Persistent second-degree atrioventricular block following adenosine infusion for nuclear stress testing

Cited by 13 publications

References 10 publications

Feasibility and safety of adenosine cardiovascular magnetic resonance in patients with MR conditional pacemaker systems at 1.5 Tesla

Feasibility and safety of adenosine cardiovascular magnetic resonance in patients with MR conditional pacemaker systems at 1.5 Tesla

Adenosine-Assisted Management of Intracranial Aneurysm

The Use of Adenosine in Cerebral Aneurysm Clipping: A Review

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