Adenosine induced ventricular fibrillation in Wolff-Parkinson-White syndrome.
VF was observed in four patients (group A) with preexcited AF presenting to the emergency department who had been given 12 mg of adenosine. These patients were resuscitated and underwent electrophysiological study and catheter ablation of the accessory pathway (AP). In a control (group B) of five patients with manifest AP, sustained AF was induced by rapid atrial pacing during electrophysiological study and 12 mg of adenosine was administered. The ECG and electrophysiologic features in the two groups were compared. All patients had a single manifest AP. In group A, three patients had a left free-wall AP and one patient had a posteroseptal AP, while in the control group all had left free-wall APs. The antegrade AP effective refractory period (ERP) in groups A and B was 227 +/- 29 and 289 +/- 37 ms, respectively (P < 0.05). The atrial ERP was 210 +/- 17 versus 219 +/- 21 ms, respectively, in groups A and B (P > 0.05). The shortest R-R interval during AF in group A was 246 +/- 51 ms and 301 +/- 60 ms in group B (P value < 0.05). After adenosine, no patient in group B developed VF. Adenosine may cause VF when administered during preexcited AF. This phenomenon is seen in patients having APs with short refractory periods.
Gupta
Anoop K
AK
Thoracic and Cardiovascular Institute, Michigan State University and Sparrow Health System, Lansing 48912, USA.
Shah
Chetan P
CP
Maheshwari
Alok
A
Thakur
Ranjan K
RK
Hayes
Oliver W
OW
Lokhandwala
Yash Y
YY
D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D000075202:Contraindications; D004562:Electrocardiography / Q000187:drug effects*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D011226:Pre-Excitation Syndromes / Q000503:physiopathology* / Q000628:therapy; D012307:Risk Factors; D014693:Ventricular Fibrillation / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D014927:Wolff-Parkinson-White Syndrome / Q000503:physiopathology* / Q000628:therapy
D000241:Adenosine