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European Heart Journal Advance Access published online on March 30, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi844
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received September 7, 2005
Revised January 27, 2006
Accepted March 9, 2006

Review

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

Steve W. Parry 1 *, Samiran Nath 2, John P. Bourke 3, Rodney S. Bexton 2, and Rose Anne Kenny 4

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

* To whom correspondence should be addressed.
Steve W. Parry, E-mail: steve.parry{at}nuth.nhs.uk


  Abstract

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.

Keywords: Syncope; Adenosine; Adenosine triphosphate; Sinus node; Atrioventricular block; Neurally mediated syncope.
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