title: Life-threatening alterations in heart rate after the use of adenosine in atrial flutter.
abstract: Adenosine has become the preferred treatment for common types of supraventricular tachycardia because it is extremely effective and rarely associated with with serious side effects. It has also been advocated as an intervention for diagnostic use to assess uncommon types of tachycardia. Evidence is shown in this report that adenosine was associated with dangerous worsening of arrhythmia in patients with atrial flutter. In two patients, adenosine precipitated acceleration of ventricular response, in one case necessitating emergent cardioversion. Both patients had atrial flutter with 2 to 1 atrioventricular block that evolved into 1 to 1 atrioventricular conduction. In three other patients, adenosine was associated with prolonged bradyasystole and hypotension. In each of the five patients, adenosine was given in a standard fashion (6 or 12 mg). In summary, adenosine should be recognized as a potentially dangerous intervention in patients with atrial flutter. If it is used for diagnostic purposes, resuscitative equipment should be readily available.
authors.affiliation: Department of Medicine, University of California-Irvine Medical Center, Orange 92613-1491, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Brodsky
authors.forename: C
authors.initials: C
authors.lastname: Hwang
authors.forename: D
authors.initials: D
authors.lastname: Hunter
authors.forename: P S
authors.initials: PS
authors.lastname: Chen
authors.forename: D
authors.initials: D
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: Ariani
authors.forename: W D
authors.initials: WD
authors.lastname: Johnston
authors.forename: B J
authors.initials: BJ
authors.lastname: Allen
authors.forename: J G
authors.initials: JG
authors.lastname: Chun
authors.forename: C R
authors.initials: CR
authors.lastname: Gold
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000175:diagnosis; D001282:Atrial Flutter / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004562:Electrocardiography / Q000187:drug effects; D004630:Emergencies; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000241:Adenosine