Unmasking Adenosine: The Purinergic Signalling Molecule Critical to Arrhythmia Pathophysiology and Management

Area of Science:

• Cardiology
• Clinical Electrophysiology

Background:

• Adenosine, identified in 1929, has negative chronotropic and dromotropic effects, suggesting early therapeutic potential for arrhythmias.
• Since the 1980s, adenosine has been a primary treatment for atrioventricular node reentrant tachycardia (AVNRT) and other supraventricular tachycardias (SVTs).

Purpose of the Study:

• To review 90 years of adenosine use in managing supraventricular tachycardia (SVT).
• To evaluate adenosine's safety profile, including potential adverse effects and its role in interventional electrophysiology.
• To contextualize adenosine's application within new European Society of Cardiology guidelines for SVT management.

Main Methods:

• Literature review of adenosine's historical and current applications in arrhythmia management.
• Analysis of adenosine's pharmacokinetic and pharmacodynamic properties.
• Examination of adenosine's association with various pathologies and potential adverse events.

Main Results:

• Adenosine is highly effective in terminating SVTs involving the atrioventricular node and unmasking underlying rhythms.
• Despite its short half-life and general safety, adenosine can induce arrhythmias (AF, bradyarrhythmia, ventricular tachyarrhythmia) and bronchospasm.
• Adenosine's use is relevant in conditions like heart failure, obesity, ischemia, and aging, which predispose to arrhythmias.

Conclusions:

• Adenosine remains a cornerstone therapy for specific SVTs, with established efficacy in electrophysiology.
• Understanding adenosine's potential adverse effects and patient-specific risk factors is crucial for safe clinical application.
• Current guidelines emphasize a comprehensive approach to SVT management, integrating adenosine's role with evolving therapeutic strategies.