Which cardiac rhythms respond to adenosine (adenosine)

From the Guidelines

Adenosine is most effective for terminating supraventricular tachycardias (SVTs) involving the AV node, specifically atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT). According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1, adenosine is beneficial for acute treatment in patients with orthodromic AVRT, with a success rate of 90% to 95%. The guideline also recommends vagal maneuvers as the first-line intervention to terminate SVT.

Rhythms Responsive to Adenosine

• Atrioventricular nodal reentrant tachycardia (AVNRT)
• Atrioventricular reentrant tachycardia (AVRT), including those involving accessory pathways like in Wolff-Parkinson-White syndrome
• Adenosine can also be useful for diagnosing atrial tachycardias by temporarily blocking AV conduction, revealing the underlying atrial activity

Important Considerations

• Adenosine is ineffective for ventricular tachycardias, atrial fibrillation, atrial flutter, and multifocal atrial tachycardia
• The drug has an extremely short half-life of less than 10 seconds, making its effects transient but also minimizing prolonged side effects
• Caution is advised when encountering pre-excited atrial fibrillation or flutter that conducts to the ventricles via both the AV node and an accessory pathway, as treatment with an AV nodal blocking agent (including adenosine) is unlikely to slow the ventricular rate and in some instances may accelerate the ventricular response 1

From the Research

Rhythms that Respond to Adenosine

The following rhythms have been shown to respond to adenosine:

• Atrioventricular nodal reentrant tachycardia: adenosine can terminate episodes of this type of tachycardia 2, 3, 4, 5
• Atrioventricular reciprocating tachycardia: adenosine can terminate episodes of this type of tachycardia 2, 3, 4, 5
• Sinus node reentrant tachycardia: adenosine can terminate episodes of this type of tachycardia 6
• Atrial tachycardia due to triggered activity: adenosine can terminate episodes of this type of tachycardia 6
• Automatic atrial tachycardia: adenosine can transiently suppress episodes of this type of tachycardia 6

Rhythms that Do Not Respond to Adenosine

The following rhythms have been shown to not respond to adenosine:

• Intraatrial reentrant tachycardia: adenosine has no effect on this type of tachycardia 2, 6
• Atrial flutter: adenosine has no effect on this type of tachycardia 2, 6
• Atrial fibrillation: adenosine has no effect on this type of tachycardia 2