Adenosine Induced Ventricular Arrhythmias in the Emergency Room

Tan, Hanno L.; Spekhorst, Hans; Peters, Ron J.G.; Wilde, Arthur A.M.

doi:10.1046/j.1460-9592.2001.00450.x

Cited by 47 publications

(26 citation statements)

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“…A number of studies [381][382][383][384][385][386][387][388][389][390][391][392][393][394][395][396][397][398] support the use of adenosine in the treatment of stable PSVT. Although 2 randomized clinical trials 383,386 documented a similar PSVT conversion rate between adenosine and calcium channel blockers, adenosine was more rapid and had fewer severe side effects than verapamil.…”

Section: Therapymentioning

confidence: 99%

Part 8: Adult Advanced Cardiovascular Life Support

Neumar¹,

Otto²,

Link³

et al. 2010

Circulation

1,348

872

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Section: Therapymentioning

confidence: 99%

Part 8: Adult Advanced Cardiovascular Life Support

Neumar¹,

Otto²,

Link³

et al. 2010

Circulation

1,348

872

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“…Besides it is a useful tool in differential diagnosis of certain supraventricular and ventricular tachycardias. However there have been several reports of proarrythmic effects after adenosine application, among them: AV-nodal conduction block, suppression of pacemaker automaticity up to total sinus arrest and asystole, atrial fibrillation, Torsade de pointes, premature ventricular complexes, non sustained ventricular tachycardia and ventricular fibrillation [1,2]. In this report we describe the first case of an adenosine induced sustained monomorphic ventricular tachycardia after termination of an AVNRT in an otherwise healthy women.…”

Section: Introductionmentioning

confidence: 81%

Sustained monomorphic ventricular tachycardia after adenosine infusion

Huemer

Boldt

Rolf

et al. 2009

International Journal of Cardiology

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“…To date, while the association between adenosine infusion and ventricular arrhythmias is well known [6][7][8][9], little is still known about the adenosine induced supraventricular arrhythmias. The possible mechanisms underlying proarrhythmic effect of adenosine are summarized in Figure 3.…”

Section: Discussionmentioning

confidence: 99%

Unusual Side Effect of Adenosine Infusion

Russo¹

2013

Anat Physiol

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A 22 year old man was referred to our observation for recurrent palpitations at rest which subside after few minutes. The medical history was negative for familiar sudden death, dizziness or syncope. His body weight was 75 kg and his height was 170 cm. Physical examination revealed a blood pressure of 130/70 mmHg, clear lungs and normal heart sounds. Hematological examination, urinary analysis and thyroid function were all normal. He had no past medical history and denied taking alcohol, tobacco or any medications. Electrocardiographic (ECG) examination showed sinus rhythm of 75 beats/minute, normal atrioventricular conduction (PR: 120 ms), mild slurred QRS upstroke in leads V3-V4, no ST segment or T wave changes (Figure 1). Neither chest x-ray or color-doppler echocardiography revealed any cardiac structural or functional abnormalities. 24 hours ECG Holter monitoring and treadmill stress test did not show arrhythmias. He underwent transesophageal electrophysiological evaluation: the atrioventricular node refractory period was 240 msec. During the test it was not used any anesthesia. The patient was conscious during the entire test and its O 2 saturation, measured at pulse oximeter, was consistently 98-99%. Programmed atrial stimulation up to two extrastimuli did not induce supraventricular arrhythmias. Intravenous adenosine (12 mg) was performed for slowing of AV conduction and unmasking unapparent pathways. After a single-bolus, rapidly followed by saline flush, a sinus tachycardia at a frequency of 145 beats/min was induced. It was self-terminated in approximately 50 seconds, without change in QRS morphology (Figure 2). At the second adenosine bolus, carried out about 5 minutes later, similar effect was induced. Patient remained conscious and asymptomatic during the tachycardia. DiscussionAdenosine is an endogenous nucleoside whose actions were first investigated by Drury and Szent-Gyorgyi [1]. They described a slowing of sinus rate and a reduction of conduction through the atrioventricular node in the hearts of laboratory mammals. The adenosine test seems to have good sensitivity for unmasking pre-excitation about 76-100% in small series [2,3], because it extends the atrioventricular node refractory period favoring anterograde conduction through an accessory pathway. The electrophysiologic effects of adenosine on a specific AV bypass tract depend on the type of cell that the tract consists: nodal type cells (with decremental conduction) or atrial myocytes. In sinoatrial nodal cells, the activation of a potassium outward current results in a reduced rate of phase IV depolarization, thereby slowing sinoatrial node automaticity.In the AV node, adenosine prolongs postrepolarization refractoriness and suppresses excitability of cells in the N region of the node, resulting in AV nodal conduction block of variable degrees.Some authors reported serious adverse events related to the adenosine infusion, including supraventricular and life threatening ventricular arrhythmias [4,5]. To date, while the association betwee...

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Adenosine Induced Ventricular Arrhythmias in the Emergency Room

Cited by 47 publications

References 0 publications

Part 8: Adult Advanced Cardiovascular Life Support

Part 8: Adult Advanced Cardiovascular Life Support

Sustained monomorphic ventricular tachycardia after adenosine infusion

Unusual Side Effect of Adenosine Infusion

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