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Adenosine: potential modulator for vasovagal syncope

W K Shen1, S C Hammill, T M Munger

  • 1Division of Cardiovascular Diseases and Internal Medicine, Section of Biostatistics and Peripheral Neuropathy Research Laboratory, Mayo Clinic, Rochester, Minnesota 55905, USA.

Journal of the American College of Cardiology
|July 1, 1996
PubMed
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Adenosine can trigger vasovagal responses in susceptible patients by directly activating cardiac nerves and indirectly through vasodilation. This finding is crucial for understanding syncope triggers.

Area of Science:

  • Cardiology
  • Neuroscience
  • Pharmacology

Background:

  • Increased sympathetic activity precedes vasovagal syncope.
  • Adenosine activates cardiovascular afferent nerves, increasing sympathetic discharge.
  • Adenosine has direct bradycardiac and vasodilatory effects.

Purpose of the Study:

  • To test if adenosine provokes vasovagal responses in susceptible patients.
  • To explore adenosine-mediated mechanisms of vasovagal responses.
  • To evaluate adenosine's role in syncope.

Main Methods:

  • Prospective evaluation of adenosine and head-up tilt-table testing in 85 syncope patients.
  • Sequential administration of 6 mg and 12 mg adenosine boluses in upright position.
  • Control group of 14 healthy subjects underwent the same protocol.

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Main Results:

  • Adenosine induced transient hypertension/tachycardia (sympathetic activation) and later hypotension/reflex tachycardia (baroreceptor unloading).
  • Vasovagal response induced by adenosine (26%) and tilt-table testing (34%) were comparable.
  • One control subject (7%) experienced a vasovagal response with adenosine, and one with tilt-table testing.

Conclusions:

  • Adenosine modulates cardiac excitatory afferent nerves.
  • Adenosine triggers sympathetic activation directly and indirectly.
  • Adenosine is a potential endogenous modulator for vasovagal responses in syncope patients.