title: Asystole following regadenoson infusion in stable outpatients.
abstract: Regadenoson is a selective A2A receptor agonist approved for use as a pharmacologic stress agent for myocardial perfusion imaging after several multicenter trials demonstrated its equivalence in diagnostic accuracy for the detection of coronary artery disease and a decreased incidence of serious side effects as compared to adenosine. Recently, the FDA released a safety announcement advising of the rare but serious risk of heart attack and death associated with regadenoson and adenosine in cardiac stress testing, particularly in patients with unstable angina or cardiovascular instability. We report two cases of asystole with hemodynamic collapse in stable outpatients soon after receiving a standard regadenoson injection. The prevalence of potentially life threatening bradycardia, including asystole, associated with the use of regadenoson may be greater than previously expected. These cases highlight the need for cardiac stress labs to anticipate the potential for serious side effects with all patients during the administration of coronary vasodilators.
authors.affiliation: Maine Medical Center, Department of Cardiac Services, Tufts University School of Medicine, 22 Bramhall St, 119 Gannett Drive, Portland, ME, 04106, USA, jrosedeb@maine.rr.com.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rosenblatt
authors.forename: Deirdre
authors.initials: D
authors.lastname: Mooney
authors.forename: Timothy
authors.initials: T
authors.lastname: Dunn
authors.forename: Mylan
authors.initials: M
authors.lastname: Cohen
mesh_terms: D058908:Adenosine A2 Receptor Agonists / Q000009:adverse effects*; D000368:Aged; D000553:Ambulatory Care; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D005080:Exercise Test / Q000009:adverse effects*; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000009:adverse effects*; D011687:Purines / Q000009:adverse effects*; D011720:Pyrazoles / Q000009:adverse effects*; D014665:Vasodilator Agents / Q000009:adverse effects*
chemical_list: D058908:Adenosine A2 Receptor Agonists; D011687:Purines; D011720:Pyrazoles; D014665:Vasodilator Agents; C430916:regadenoson