Adenosine induced transient cardiac standstill in catheter interventional procedures for congenital heart disease.
OBJECTIVE
To describe the use of intravenous adenosine to create transient cardiac standstill during balloon dilatation procedures for congenital heart defects.


METHODS
A tertiary paediatric cardiac centre.


METHODS
This was a prospective pilot study. Thirteen patients born with congenital heart disease and who had stenotic lesions requiring relief were considered for the technique. All were suitable for balloon dilatation. Their ages ranged from 2 months to 30 years, mean (SD) 9.9 (9.8) years. The dose of adenosine varied from 0.125 mg/kg to 0.555 mg/kg, mean 0.33 (0.127).


RESULTS
Two patients only developed sinus bradycardia in response to adenosine, which may have been related to the technique of administration. The other 11 experienced a period of asystole, which ranged from 2.4 to 10.8 seconds, mean 4.99 (2.27), and a total atrioventricular block period of 5.0 to 21.2 seconds, mean 9.47 (4.64). The interval between adenosine injection and the onset of asystole varied from 2.4 to 15.8 seconds, mean 8.05 (3.6), depending on cannula size, site of administration, and cardiac output. The peak gradient across the stenotic lesions fell from 52.3 (23.7) to 17.8 (11.9) mm Hg (p < 0.001). Apart from one short episode of atrial fibrillation there were no complications.


CONCLUSIONS
Intravenous adenosine is a safe and effective agent for creating transient cardiac standstill during balloon dilatation procedures for congenital heart disease. This achieves stability which is likely to improve results and reduce complications. It may have applications in other fields of cardiac intervention where an immobile heart is desirable during the critical phase of a procedure.
De Giovanni
J V
JV
Heart Unit, Birmingham Children's Hospital NHS Trust, Birmingham, UK.
Edgar
R A
RA
Cranston
A
A
D000241:Adenosine / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D002404:Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D007432:Intraoperative Period; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000241:Adenosine