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Discordant Effects of Carotid Sinus Massage and Intravenous Adenosine in Atypical (Fast‐Slow) Atrioventricular Nodal Reentrant Tachycardia
Author(s) -
MILCHAK MARK A.,
GREENBERG MARK L.
Publication year - 1989
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1989.tb01883.x
Subject(s) - medicine , cardiology , tachycardia , adenosine , supraventricular tachycardia , carotid sinus , massage , nodal , anesthesia , atrioventricular reentrant tachycardia , electrocardiography , accessory pathway , catheter ablation , atrial fibrillation , pathology , blood pressure , alternative medicine
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.