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Adenosine hypersensitivity and atrioventricular block

Adenosinhypersensitivität und atrioventrikulärer Block

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Adenosine is a ubiquitous substance that is released under several physiological and pathological conditions and has cardiovascular effects including cardioinhibition and vasodilation. It has been shown to be an important modulator implicated in several forms of syncope. In patients with chronic low plasma levels of adenosine, a transient release of endogenous adenosine can be sufficient to block conduction in the atrioventricular node and induce prolonged asystole; conversely, when plasma adenosine levels are chronically high, adenosine release is responsible for vasodepression. Distinct purinergic profiles in patients presenting with syncope have recently been correlated with the clinical presentation: “low-adenosine patients,” prone to asystole, may present with idiopathic atrioventricular block, carotid sinus syndrome, or syncope with no or very brief prodromes and normal heart; “high-adenosine patients,” prone to vasodilation, experience vasovagal syncope. This pathophysiological classification may have therapeutic implications.


Adenosin ist eine allgemein vorkommende Verbindung, die unter vielen physiologischen wie auch pathologischen Bedingungen freigesetzt wird und kardiovaskuläre Effekte hat, unter anderem auch kardioinhibitorische und vasodilatatorische. Es ist belegt, dass Adenosin als wichtiger Modulator in Bezug auf verschiedene Synkopeformen fungiert. Bei Patienten mit chronisch niedrigen Adenosinplasmaspiegeln kann eine transiente Freisetzung von endogenem Adenosin ausreichend sein, um die Erregungsleitung im atrioventrikulären (AV) Knoten zu blockieren und eine anhaltende Asystolie hervorzurufen. Umgekehrt hat die Adenosinfreisetzung bei chronisch hohen Plasmaspiegeln eine vasodepressorische Wirkung. Unterschiedliche purinerge Profile von Patienten mit Synkope sind in jüngerer Zeit mit dem klinischen Bild in Beziehung gebracht worden: Patienten mit niedrigem Adenosinspiegel neigen zu Asystolie und können einen idiopathischen AV-Block, ein Karotissinussyndrom oder eine Synkope ohne oder mit sehr kurzen Prodromen und normalem Herzen aufweisen; Patienten mit hohem Adenosinspiegel neigen zu Vasodilatation und zeigen vasovagale Synkopen. Diese pathophysiologische Klassifikation könnte von therapeutischer Relevanz sein.

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Correspondence to Jean-Claude Deharo MD.

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J.-C. Deharo, M. Brignole and R. Guieu declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Deharo, JC., Brignole, M. & Guieu, R. Adenosine hypersensitivity and atrioventricular block. Herzschr Elektrophys 29, 166–170 (2018).

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