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Adenosine-Induced Atrial Arrhythmia.

Adenosine is frequently used for the treatment of paroxysmal supraventricular tachycardia (PSVT), but there has been concern that adenosine in this setting can trigger atrial fibrillation or flutter in some patients. To test this hypothesis, University of Michigan investigators prospectively administered 12 mg of intravenous adenosine to 200 consecutive patients undergoing electrophysiologic evaluation of PSVT.

The mechanism responsible for PSVT was atrioventricular nodal reentrant tachycardia in 124 patients, atrioventricular reciprocating tachycardia in 68, and atrial tachycardia in 8. Adenosine induced atrial fibrillation or flutter in 12 percent of patients. In all cases, atrial fibrillation developed after an atrial premature beat causing a long-short sequence typically associated with reentrant arrhythmias. Of note, there was no association between the underlying mechanism of the PSVT and the risk for adenosine-induced atrial fibrillation or flutter.

Comment: This prospective study clearly demonstrates an association between administration of 12 mg of IV adenosine and post-cardioversion atrial arrhythmias, at least in the electrophysiology laboratory. The authors point out that these acute rhythms can be quite dangerous in the presence of a concealed, antegrade conducting bypass tract. Thus, in patients with PSVT where a bypass tract mechanism may be responsible, adenosine should be used only where emergency resuscitation is feasible.

— MS Lauer

Published in Journal Watch Cardiology November 10, 1997

Citation(s):

Strickberger SA et al. Adenosine-induced atrial arrhythmia: A prospective analysis. Ann Intern Med 1997 Sep 15 127 417-422.

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