Adenosine-induced atrial arrhythmia: a prospective analysis.
BACKGROUND
Adenosine is considered safe and effective for paroxysmal supraventricular tachycardia (PSVT), but anecdotal experience suggests that adenosine can precipitate atrial arrhythmias.


OBJECTIVE
To determine the frequency and mechanisms of adenosine-induced atrial arrhythmias.


METHODS
Clinical electrophysiology laboratory at a university medical center.


METHODS
Prospective observational study.


METHODS
200 consecutive patients with PSVT undergoing an electrophysiology procedure.


METHODS
During PSVT, 12 mg of adenosine was administered centrally through the femoral vein.


METHODS
Frequency of adenosine-induced atrial fibrillation.


RESULTS
Paroxysmal supraventricular tachycardia terminated after adenosine administration in 198 patients (99% [95% CI, 96% to 100%]). Adenosine led to atrial fibrillation (n = 22) or atrial fibrillation and atrial flutter (n = 2) in 24 patients (12% [CI, 7.5% to 16.5%]). An atrial premature complex occurred in all 24 patients who developed atrial fibrillation, atrial flutter, or both and in 102 of the 176 patients (58%) who did not (P < 0.001). The mean (+/-SD) time from the preceding atrial complex to the atrial premature complex was shorter when an atrial arrhythmia occurred, and the mean ratio of this interval to the preceding atrial cycle length was also lower when atrial fibrillation developed (0.37 +/- 0.16 compared with 0.49 +/- 0.16; P = 0.002).


CONCLUSIONS
The incidence of atrial fibrillation induced by 12 mg of adenosine administered through the femoral vein was 12%. Fibrillation seems to be associated with a "long-short" atrial sequence. If the mechanism of PSVT is unknown and the Wolff-Parkinson-White syndrome is possible, administration of adenosine should be limited to medical facilities that have emergency resuscitation equipment.
Strickberger
S A
SA
University of Michigan Medical Center, Ann Arbor, USA.
Man
K C
KC
Daoud
E G
EG
Goyal
R
R
Brinkman
K
K
Knight
B P
BP
Weiss
R
R
Bahu
M
M
Morady
F
F
D000241:Adenosine / Q000009:adverse effects*; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000139:chemically induced*; D001282:Atrial Flutter / Q000139:chemically induced*; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013614:Tachycardia, Paroxysmal / Q000188:drug therapy* / Q000503:physiopathology; D013617:Tachycardia, Supraventricular / Q000188:drug therapy* / Q000503:physiopathology; D014927:Wolff-Parkinson-White Syndrome / Q000139:chemically induced
D000889:Anti-Arrhythmia Agents; D000241:Adenosine