Sinus arrest during adenosine stress testing in liver transplant recipients with graft failure: three case reports and a review of the literature.
BACKGROUND
Nuclear stress imaging is used frequently to evaluate patients with end-stage liver disease who are being considered for orthotopic liver transplantation.


RESULTS
We present three patients who, following graft failure, developed sinus arrest during adenosine stress testing performed in anticipation of repeat liver transplantation. All had undergone uneventful adenosine stress imaging prior to initial transplantation. The mechanisms of action, pharmacokinetics, and pharmacodynamics of adenosine are reviewed, and possible reasons for this phenomenon are discussed. Finally, cautions regarding the use of adenosine and treatment of adenosine-induced sinoatrial and atrioventricular block are reviewed.


CONCLUSIONS
Adenosine should be used with caution in patients following orthotopic liver transplantation due to an increased risk of sinus arrest. Should sinus arrest or atrioventricular block occur, it appears to respond readily to cessation of adenosine infusion and intravenous aminophylline with no significant sequelae.
Giedd
Kenneth N
KN
Division of Cardiology, Beth Israel Medical Center, New York, NY, USA. kgiedd@chpnet.org
Bokhari
Sabahat
S
Daniele
Teresa P
TP
Johnson
Lynne L
LL
D000241:Adenosine / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D001146:Arrhythmia, Sinus / Q000139:chemically induced* / Q000175:diagnosis*; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging
D000241:Adenosine