Electrophysiologic effects of intravenous adenosine triphosphate disodium on the paroxysmal supraventricular tachycardias.

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Abstract
The electrophysiologic effects of i.v. adenosine triphosphate disodium(ATP-2Na) on 15 patients with paroxysmal supraventricular tachycardias (PSVT). One patient had sinus node (SN) reentry and 2 patients had intraatrial (IA) reentry. Five patients had AV (atrioventricular) nodal reentry and 7 patients had AV reentrant tachycardias (AVRT) with accessory pathways (AP). ATP-2Na was injected during ventricular pacing (VP) in patients with AVRT with AP. A bolus injection of ATP-2Na terminated all the PSVT within 40 except in 1 case of IA reentry. The sites of block at the termination were the atrium in SN reentry and IA reentry, between A (atrium) and H (Hisis) (AH) block or between H and A (HA) block in AV nodal reentry and AH block in all the AVRT with AP. ATP-2Na during VP in patients with AVRT with AP produced the changes of atrial activation sequences in 3 patients, induction of PSVT in 2 patients and a Mobitz type II VA block in 2 patients. The former 2 phenomena suggested a retrograde AV nodal block and raised the possibility of a simple test for retrograde atrial fusion during VP in patients with Wolf-Parkinson-White syndrome. Chest discomfort of short duration was most commonly noted after ATP-2Na. Inosine pretreatment potentiated the effects of ATP-2Na. This combination may further alleviate the side effects of ATP-2Na, while preserving the effective action of ATP-2Na for rapid termination of PSVTs.

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