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Adenosine-Induced Atrial Arrhythmia: A Prospective Analysis
Abstract
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.
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“However, adenosine can produce a rebound increase of AV conduction to 1:1, and may also precipitate AF. 177,178”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [178]
In the citing paper
“However it should be used with caution because of potential induction of fast AF. 178”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [178]
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“Several studies in larger mammals have demonstrated that increased vagal tone, or adenosine administration, can promote the genesis of AF (1,20,21).”
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“In addition, adenosine has been shown to promote the development of AF in ≤ 15% of patients [32] .”
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“Although adenosine is effective at terminating supraventricular tachycardias with atrioventricular (AV) nodal involvement, it may induce AF, with an incidence of 1–12%.([12-14]) Episodes of adenosine-induced AF have been reported to be short lived and transient during stress testing, as a result of adenosine’s short h…”
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“Two large adult series, in which the effects of adenosine were evaluated during invasive electrophysiology studies, demonstrated an incidence of adenosine-induced atrial fibrillation between 8% and 12%.(6,7) We reviewed our experience with administering adenosine to pediatric patients who were referred to our electrop…”
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P REHOSPITAL M ANAGEMENT OF A CUTE T ACHYARRHYTHMIAS
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“Furthermore, adenosine results in a reflex increase in circulating catecholamine levels and sympathetic activation, which may cause atrial ectopy [1].”
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Self-citationUse of medications in Wolff-Parkinson-White syndrome
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“In addition, the ability of adenosine to enhance automaticity can be pro-arrhythmic, with induction of AF and short bursts of non-sustained ventricular tachycardia occasionally observed [15].”
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“17,18 While its impact is brief because of its short half-life (lasting only 20–30 seconds), this poses a significant risk, especially in patients with Wolff-Parkinson-White (WPW) syndrome, as it can potentially progress to VF and result in unstable haemodynamics.”
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“Besides the bradycardic effects of adenosine, it is known that intravenous adenosine administration could cause spontaneous AF [15].”
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“The rationale of using selective A 1 AR agonists instead of adenosine itself lies in the possibility of avoiding the side effects of the nucleoside, particularly flushing, dyspnoea, chest discomfort, hypotension [55] and promotion, instead of reduction, of AF in ≤ 15% patients [56] .”
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“A shortened atrial refractory period resulting from a reflex increase in circulating catecholamine levels caused by adenosine is another mechanism that has been proposed.(1) Ventricular tachycardia and ventricular fibrillation have been reported with adenosine as well.”
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Adenosine-Induced Atrial Instability
Raviña, T., Raviña, P., & Suárez, M. L. R. (2004) · Revista Española de Cardiología (English Edition) · doi:10.1016/s1885-5857(06)60638-5 · Cited by 1
Adenosine-induced ventricular flutter in an ethanol-intoxicated patient
Tsai, W. D., & Tsai, J. (2002) · The American Journal of Emergency Medicine · doi:10.1053/ajem.2002.31134 · Cited by 1
Morgan‐Hughes, N. J. (2002) · British Journal of Anaesthesia · doi:10.1093/bja/aef570 · Cited by 1
Morgan‐Hughes, N. J., Heames, R. M., Hack, H., et al. (2002) · British Journal of Anaesthesia · doi:10.1093/bja/89.5.798 · Cited by 1
Approach to the Patient with Supraventricular Tachycardia
Ganz, L. I. (2002) · Contemporary cardiology · doi:10.1007/978-1-59259-090-2_3
Adenosine: Use as a Diagnostic and Therapeutic Tool
CONTI, J. B., & Curtis, A. B. (2000) · Cardiac Electrophysiology Review · doi:10.1023/a:1026579012058
Adenosine for Unmasking Latent Pre-Excitation: an Unpleasant Surprise
Georgios, S., Almpanis, G., Papathanassiou, P., et al. (2012) · Hospital chronicles/Hospital Chronicles
Fibrilación auricular transitoria inducida por adenosina en una paciente con taquicardia auricular
Alberola, A. G., Agüera, A. G., Sánchez-Muñoz, J.-J., Sánchez, J. M., Lázaro, C. L., & Chávarri, M. V. (2002) · Anales de Medicina Interna · doi:10.4321/s0212-71992002000600007
Noninvasive Diagnosis of Cardiac Arrhythmias Using Adenosine Compounds
Belhassen, B. (2001) · Annals of Noninvasive Electrocardiology · doi:10.1111/j.1542-474x.2001.tb00141.x
Antiarrhythmic Drug Therapy of Supraventricular Tachycardia
Rothman, S. A. (2010) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2010.07.003
Adenosin bei supraventrikulären Tachykardien?
Hussein, A., Kattenbeck, K., & Trappe, H. (1998) · Medizinische Klinik - Intensivmedizin und Notfallmedizin · doi:10.1007/bf03042645
Diagnostik og behandling af paroksystisk supraventrikulær takykardi
Rujic, D., Sundbøll, J., Tofig, B. J., Nielsen, J. C., & Pareek, M. (2016) · Ugeskrift for Læger
Acute and Chronic Pharmacologic Management of Supraventricular Tachycardias
Mangrum, J. M., Ferguson, J., & Dimarco, J. (2007) · Elsevier eBooks · doi:10.1016/b978-1-4160-3358-5.50029-2
Drug-Induced Atrial Fibrillation
(2012) · WORLD SCIENTIFIC eBooks · doi:10.1142/9789814317467_0008
Metadata
- Authors
- Strickberger, S. A., Man, K. C., Daoud, E. G., Goyal, R., Brinkman, K., Knight, B. P., Weiss, R., Bahu, M., & Morady, F.
- Affiliations
- University of Michigan (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1997-09-15
- Volume
- 127
- Issue
- 6
- Pages
- 417-422
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2045925368
- Cited by
- 124
- References
- 0
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 7 · 2019: 5 · 2018: 2 · 2017: 4 · 2016: 6 · 2015: 2 · 2014: 5 · 2013: 2 · 2012: 9
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- adenosine, atrial fibrillation, atrial arrhythmias, paroxysmal supraventricular tachycardia, atrial flutter, premature atrial contractions, Wolff-Parkinson-White syndrome, catheter ablation complications
- MeSH terms
- Adenosine, Adult, Anti-Arrhythmia Agents, Atrial Fibrillation, Atrial Flutter, Electrocardiography, Female, Heart Atria, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Tachycardia, Paroxysmal, Tachycardia, Supraventricular, Wolff-Parkinson-White Syndrome
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