Adenosine in wide complex tachycardia: potential pitfalls in diagnostic value.
Adenosine is an efficacious diagnostic and therapeutic agent in the acute management of wide complex tachycardias. Its potent negative dromotropic effect terminates supraventricular tachycardias involving the atrioventricular node, allowing differentiation from tachycardias of atrial and ventricular origin. Its extranodal actions, however, may lead to potential pitfalls in arrhythmia diagnosis. We report three unusual cases of patients with adenosine-sensitive tachycardias. One patient had idiopathic ventricular tachycardia originating from the right ventricular outflow tract, one had ectopic atrial tachycardia, and one had atrial fibrillation with rate-related intraventricular aberration. Recognition of the extranodal actions of adenosine and careful ECG evaluation before and after adenosine administration should maximize the diagnostic accuracy of adenosine in wide complex tachycardias.
Lee
K L
KL
Department of Medicine, Queen Mary Hospital, University of Hong Kong.
Tai
Y T
YT
D000255:Adenosine Triphosphate / Q000627:therapeutic use*; D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008875:Middle Aged; D013610:Tachycardia / Q000175:diagnosis* / Q000188:drug therapy; D013612:Tachycardia, Ectopic Atrial / Q000188:drug therapy / Q000503:physiopathology; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000503:physiopathology
D000255:Adenosine Triphosphate