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Adenosine in the mammalian heart: nothing to get excited about
1Allagheny University of Health Sciences, Likoff Cardiovascular Institute, Department of Medicine, Philadelphia, PA 19102-1192, USA.
Insights
Adenosine, a nucleoside, is clinically used for supraventricular tachycardia. Despite recent studies showing paradoxical excitatory heart effects in animals, its clinical relevance remains minimal.
Area of Science:
- Cardiology
- Pharmacology
- Molecular Biology
Background:
- Adenosine is a nucleoside known for its cardiodepressant effects.
- It is clinically utilized for supraventricular tachycardia and acts as an endogenous antiarrhythmic metabolite.
Purpose of the Study:
- To review the established cardiodepressant actions of adenosine.
- To address recent findings suggesting paradoxical excitatory effects of adenosine in the heart.
- To argue for the clinical irrelevance of these observed excitatory actions.
Main Methods:
- Review of existing literature on adenosine's cardiac effects.
- Analysis of in vitro experimental data from animal models.
- Clinical perspective on the significance of adenosine's actions.
Main Results:
- Recent in vitro studies using animal models indicate a paradoxical excitatory action of adenosine in the heart.
- Established clinical use and endogenous function support adenosine's antiarrhythmic role.
Conclusions:
- Despite in vitro evidence of excitatory effects, the clinical relevance of adenosine's paradoxical actions in the heart is considered minimal.
- Adenosine's role as a clinically effective antiarrhythmic agent remains significant.
Abstract:
Until quite recently, the cardiodepressant actions of adenosine were widely accepted. A nucleoside that produces negative chronotropic and ionotropic effects, adenosine, has been used clinically as the drug of choice for terminating supraventricular (atrioventricular node) tachycardia and is likely to play an important part in regulating arrhythmogenic activity as an endogenous antiarrhythmic metabolite. Despite this, recent experimental data, particularly resulting from in vitro studies using animal models, have shown a paradoxical excitable action of adenosine in the heart. In this article, Amir Pelleg and Steven Kutalek present the reasons why they continue to believe that any excitatory actions of adenosine in the heart are clinically irrelevant.