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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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Items 101–124 of 124
Atrial Fibrillation: Epidemiology and Demographics
Soto‐Ruiz, K. M. (2016) · Contemporary cardiology · doi:10.1007/978-3-319-31386-3_1
Atrial Fibrillation Induction in a Pediatric Patient during Adenosine Administration
Robinson, J. A., & Snyder, C. S. (2017) · World Journal of Cardiovascular Diseases · doi:10.4236/wjcd.2017.73006
“In a prospective series of 200 adult patients with known paroxysmal supraventricular tachycardia (SVT) referred for EP study, 12% of patients developed atrial fibrillation with or without atrial flutter following administration of adenosine 12 mg IV [7] [8].”
BackgroundPharmacologic Management of Supraventricular Tachycardias
Dimarco, J., Mangrum, J. M., & Ferguson, J. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4557-0101-8.00019-9
How to Induce Arrhythmias with Adenosine?
Cainap, S. S. (2019) · Springer eBooks · doi:10.1007/978-3-319-92729-9_14
Atrio-ventricular Nodal Reentry
Rothman, S. A. (2020) · Contemporary cardiology · doi:10.1007/978-3-030-41967-7_13
Ablation therapy and implantable device based approaches for supraventricular arrhythmias
Patel, N. K., & Link, M. S. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-813704-8.00033-4
Diagnosis and Treatment of Unstable Supraventricular Tachycardia
Patel, N. K., & Link, M. S. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-52993-8.00025-4
Katritsis, D. G., & Morady, F. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-79338-4.00021-2
Self-citationDrug-Induced Atrial Fibrillation / Atrial Flutter
Ostroumova, O. D., Сергеевна, Ч. М., Кочетков, А. И., Vorobieva, A. E., Bakhteeva, D. I., Korchagina, S. P., Bondarets, O. V., Boyko, N. D., & Sychev, D. A. (2022) · Rational Pharmacotherapy in Cardiology · doi:10.20996/1819-6446-2021-12-11
“Аденозин [22-40] 1-12% Способствует эктопической активности области устьев легочных вен; укорочению эффективного рефрактерного периода предсердий и развитие re-entry; повышению вегетативного и симпатического тонуса; замедлению внутрипредсердной проводимости; нарушению автоматизма и повышению возбудимости кардиомиоцито…”
InfluentialApproach to Narrow and Wide QRS Complex Tachyarrhythmias
Hanna, E. B. (2022) · doi:10.1002/9781119832737.ch8
Almuti, K., Bozorgnia, B., & Rothman, S. A. (2010) · Humana Press eBooks · doi:10.1007/978-1-60761-161-5_7
Approach to Narrow and Wide QRS Complex Tachyarrhythmias
Hanna, E. B. (2017) · doi:10.1002/9781119233503.ch8
Adenosine and adenosine triphosphate (ATP)
(2006) · Elsevier eBooks · doi:10.1016/b0-44-451005-2/01365-6
Positive inotropic drugs and drugs used in dysrhythmias
Aronson, J. K. (1999) · Side effects of drugs annual · doi:10.1016/s0378-6080(99)80022-1
Adenosine: Use as a Diagnostic and Therapeutic Tool
CONTI, J. B., Belardinelli, L., & Curtis, A. B. (1998) · Cardiac Electrophysiology Review · doi:10.1023/a:1009927727089
(2009) · Elsevier eBooks · doi:10.1016/b978-0-444-53268-8.50006-5
KHAN, M. G. (2014) · Contemporary cardiology · doi:10.1007/978-1-61779-962-4_14
Adenosine and adenosine triphosphate (ATP)
(2015) · Elsevier eBooks · doi:10.1016/b978-0-444-53717-1.00229-8
Donovan, K. D., & Hockings, B. E. F. (2002) · Critical Care and Resuscitation · doi:10.1016/s1441-2772(23)00774-3
Adenosine-induced Narrow Complex Tachycardia—An Encounter with Atrial Fibrillation: a Case Report
Panchal, V. S., Ravikumar, D. B., Prasad, R., Sivasubramanian, B. P., Thirupathy, U., Yarrarapu, S. N. S., & Venkata, V. S. (2024) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-024-01756-5
“Adenosine-induced atrial arrhythmias have been reported to occur in around 1–12% of patients [5, 6].”
Participation à l'étude du rôle du système adénosinergique en pathologie cardiovasculaire
Vairo, D. (2018) · theses.fr (ABES) · doi:10.70675/80125e1dze909z48c7z92afz5ec81b88db71
Adams, R., & Bon (2003) · PubMed Central
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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