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European Heart Journal Advance Access originally published online on March 30, 2006
European Heart Journal 2006 27(12):1396-1400; doi:10.1093/eurheartj/ehi844
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Adenosine test in the diagnosis of unexplained syncope: marker of conducting tissue disease or neurally mediated syncope?

Steve W. Parry1,2,*, Samiran Nath3, John P. Bourke2,3, Rodney S. Bexton3 and Rose Anne Kenny1,2,4

1 Falls and Syncope Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
2 School of Clinical Medicine, University of Newcastle Upon Tyne, Framlington Place, Newcastle upon Tyne, NE1 2DN, UK
3 Department of Cardiology, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK
4 Trinity College, College Green, Dublin 2, Ireland

Received 7 September 2005; revised 27 January 2006; accepted 9 March 2006; online publish-ahead-of-print 30 March 2006.

* Corresponding author. Tel: +44 191 282 5237. E-mail address: steve.parry{at}nuth.nhs.uk

Adenosine test (supine administration of a 20 mg intravenous bolus with electrocardiographic and blood pressure monitoring) has been endorsed by the European Society of Cardiology guidelines on syncope management as an ‘experimental’ test in the diagnosis of unexplained syncope. The test is quick and cheap, but there is no consensus as to what condition, if any, the adenosine test is exposing, with conducting tissue disease and neurally mediated syncope proposed by various authors. In this article, we review the possible mechanisms underlying a positive adenosine test, its safety, and a comprehensive examination of the literature supporting each of the putative causal diagnoses.

Key Words: Syncope • Adenosine • Adenosine triphosphate • Sinus node • Atrioventricular block • Neurally mediated syncope


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S. Viskin, D. Justo, and A. Halkin
Should the 'adenosine-challenge test' be part of the routine work-up for syncope?
Europace, August 1, 2007; 9(8): 557 - 558.
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