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Adenosine-Induced Atrial Arrhythmia: A Prospective Analysis

S. Adam Strickberger, MD; K. Ching Man, DO; Emile G. Daoud, MD; Rajiva Goyal, MD; Karin Brinkman, BS; Bradley P. Knight, MD; Raul Weiss, MD; Marwan Bahu, MD; and Fred Morady, MD
[+] Article and Author Information

From University of Michigan Medical Center, Ann Arbor, Michigan. Acknowledgments: The authors thank Allyson Navyac for secretarial support and Seema Sonnad, PhD, from the Consortium for Health Outcomes, Innovations and Cost Effectiveness Studies at the University of Michigan Medical Center. Requests for Reprints: S. Adam Strickberger, MD, University of Michigan Medical Center, 1500 East Medical Center Drive, Box 0022, Ann Arbor, MI 48109-0022. Current Author Addresses: Drs. Strickberger, Man, Daoud, Goyal, Knight, Weiss, Bahu, and Morady and Ms. Brinkman: University of Michigan Medical Center, 1500 East Medical Center Drive, Box 0022, Ann Arbor, MI 48109-0022. Current Author Addresses: Drs. Strickberger, Man, Daoud, Goyal, Knight, Weiss, Bahu, and Morady and Ms. Brinkman: University of Michigan Medical Center, 1500 East Medical Center Drive, Box 0022, Ann Arbor, MI 48109-0022.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;127(6):417-422. doi:10.7326/0003-4819-127-6-199709150-00001
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Background: Adenosine is considered safe and effective for paroxysmal supraventricular tachycardia (PSVT), but anecdotal experience suggests that adenosine can precipitate atrial arrhythmias.

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

Setting: Clinical electrophysiology laboratory at a university medical center.

Design: Prospective observational study.

Patients: 200 consecutive patients with PSVT undergoing an electrophysiology procedure.

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

Measurements: 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.

Figures

Grahic Jump Location
Figure 1.
A representative example of electrocardiographic recordings of paroxysmal supraventricular tachycardia (PSVT) termination after adenosine administration.

The mechanism responsible for PSVT was atrioventricular reentrant tachycardia that used a manifest left free-wall accessory pathway. From top to bottom, the figure shows leads V1, I, and II; the high right atrial (HRA) bipolar recording; a low septal right atrial (LRSA) recording; the right ventricular (RVA) bipolar recording; and lead III.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Electrocardiographic recordings showing atrial fibrillation that developed 8.8 seconds after paroxysmal supraventricular tachycardia (PSVT) was terminated by adenosine administration (shown in Figure 1).arrowFigure 1

The mechanism responsible for PSVT was atrioventricular reentrant tachycardia that used a left free-wall accessory pathway. The atrial premature complex that induced atrial fibrillation ( ) occurred 180 milliseconds after the preceding sinus beat (arrowhead). The ratio of the atrial premature complex cycle length to the preceding sinus cycle length was 0.29. The mean preexcited R-R rate during atrial fibrillation was 162 beats/min, and the shortest preexcited R-R interval was consistent with a heart rate of 200 beats/min. This figure and show recordings from the same patient. From top to bottom, the figure shows leads V1, I, and II; the high right atrial (HRA) bipolar recording; a low septal right atrial (LRSA) recording; the right ventricular (RVA) bipolar recording; and lead III.

Grahic Jump Location

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