In patients with long R-P tachycardia, intravenous adenosine may provide diagnostic clarity when the response to carotid sinus massage is misleading.
Adenosine may clarify atypical AVNRT diagnosis when carotid sinus massage misleads; single case leaves broader applicability open.
MILCHAK, M.A., et al .: Discordant Effects of Carotid Sinus Massage and Intravenous Adenosine in Atypical (Fast‐Slow) Atrioventricular Nodal Reentrant Tachycardia The precise mechanism underlying supraventricular tachycardia with a long R‐P interval is often difficult to assess noninvasively. Carotid sinus massage has been used traditionally to produce transient AV nodal conduction delay at the bedside, and may be of diagnostic or therapeutic benefit. More recently, adenosine has also been shown to be useful in this situation. We report the case of a patient with an incessant long R‐P tachycardia in whom the response to CSM was misleading while the response to adenosine was diagnostic. The electrophysiologic responses to both maneuvers are displayed, and a mechanism for the discordant responses is proposed.
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Milchak et al. (1989) studied this question.
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