Is the Adenosine Test Obsolete in the Clinical Assessment of Syncope of Unknown Origin?

Area of Science:

• Cardiology
• Clinical Neurophysiology

Background:

• Syncope affects 50% of the population, but its pathophysiology is often unclear.
• The adenosine test (ADT) is a proposed complementary diagnostic tool for syncope of unknown origin.
• Current European guidelines do not endorse ADT, despite its potential diagnostic value.

Purpose of the Study:

• To review the evidence for ADT in investigating and managing syncope.
• To highlight future research directions for ADT and adenosine pathways.
• To analyze challenges and targets in adenosine research related to syncope.

Main Methods:

• Review of existing literature on the adenosine test for syncope.
• Analysis of the role of adenosine pathways and receptors in syncope.
• Discussion of ADT's potential in diagnosis and therapy.

Main Results:

• ADT may offer insights into the pathogenetic mechanisms of spontaneous syncope.
• The test is quick, safe, and non-invasive, potentially aiding diagnosis and treatment.
• Further investigation into adenosine plasma levels and receptors is warranted.

Conclusions:

• ADT warrants further consideration for syncope work-up despite not being guideline-endorsed.
• Understanding adenosine pathways is crucial for optimizing ADT's role.
• Research into adenosine's involvement in syncope pathophysiology is ongoing.