Adenosine-5'-triphosphate test for the noninvasive diagnosis of concealed accessory pathway
Bernard Belhassen, MD, FACCa,
Roman Fish, MDa,
Sami Viskin, MDa,
Aharon Glick, MDa,
Michael Glikson, MD, FACC* and
Michael Eldar, MD, FACC*
a Departments of Cardiology, Tel-Aviv Sourasky, Tel-Aviv, Israel
* Chaim Sheba Medical Centers, and Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
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Figure 1 Patient 11. Initiation of AV reentrant echo beats following the administration of 20 mg ATP during sinus rhythm in a patient with a concealed left free wall AP and electrophysiologic evidence of antegrade dual AV node physiology. Note that the first two echo beats follow a sudden jump in PR interval of 70 ms (dual AV node physiology) while the prolongation in PR interval preceding the third echo beat is of 40 ms only. Also note that the sinus cycle length preceding the first echo beat is regular at 710 ms.
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Figure 2 Patient 22. Initiation of both AV reentrant beat and sustained AV reentrant tachycardia following the administration of 30 mg ATP in a patient with a concealed left free wall AP and electrophysiologic evidence of antegrade dual AV node physiology. The AV reentrant echo beat occurs 16 s after the ATP bolus during stable sinus rhythm (740 ms) while AV reentrant tachycardia triggered by atrial premature beats occurs 6 s later. Note that a PR jump of 80 ms is present on the beat associated with the AV reentrant echo beat.
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Figure 3 Patient 24. Initiation of AV reentrant echo beats following the administration of 30 mg ATP in a patient with a concealed posteroseptal AP and no electrophysiologic evidence of dual AV node physiology. One echo beat occurs after each of four consecutive sinus beats (QRS complexes No. 2 through No. 5) with the first echo following a slight prolongation (20 ms) in PR interval. A sinus beat associated with a shorter PR interval subsequently occurs, followed by an atrial premature beat and another AV reentrant echo beat.
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Figure 4 Patient 27. (A) Induction of a sustained AV reentrant tachycardia following the administration of 10 mg ATP in a patient with a concealed left free wall AP. About 10 s after the ATP bolus, tachycardia is initiated during stable sinus rhythm (cycle length 540 ms). Note a slight and progressive prolongation in PR interval preceding the tachycardia initiation. The right bundle branch block present is catheter-induced. (B) After radiofrequency ablation of the AP, no tachycardia is induced 10 s after administration of the same dose of ATP and achievement of sinus cycle length and PR interval similar to baseline.
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