From the Guidelines
Administering adenosine to a patient in atrial fibrillation (AFib) is not recommended as it may precipitate AF that can conduct rapidly to the ventricle and even cause ventricular fibrillation, as stated in the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1.
Consequences of Adenosine Administration in AFib
The use of adenosine in patients with AFib can have several negative consequences, including:
- Precipitation of AF that may conduct rapidly to the ventricle, potentially leading to ventricular fibrillation 1
- Transient worsening of the arrhythmia
- Unmasking of underlying atrial activity due to the temporary heart block caused by adenosine
- Brief period of very rapid ventricular response once the adenosine effect wears off
Alternative Treatments for AFib
For patients in AFib with rapid ventricular response, more appropriate treatments include:
- Rate control medications such as beta-blockers or calcium channel blockers
- Synchronized cardioversion in unstable patients It is essential to note that adenosine is primarily indicated for diagnosing and treating supraventricular tachycardias involving reentry circuits, particularly AVNRT, not for atrial fibrillation management 1.
Key Considerations
When managing patients with AFib, it is crucial to prioritize treatments that do not exacerbate the condition and to be aware of the potential consequences of administering adenosine, as highlighted in the 2015 ACC/AHA/HRS guideline 1.
From the FDA Drug Label
Adenosine injection can cause atrial fibrillation in patients with or without a history of atrial fibrillation. Atrial fibrillation typically began 1.5 to 3 minutes after initiation of adenosine injection, lasted for 15 seconds to 6 hours, and spontaneously converted to normal sinus rhythm [see Post-Marketing Experience ( 6-6.2)]. The consequences of administering adenosine to a patient in atrial fibrillation (AFib) may include:
- Worsening of the existing atrial fibrillation
- Prolongation of the atrial fibrillation episode
- Potential development of other arrhythmias It is essential to use caution when administering adenosine to patients with pre-existing atrial fibrillation. The benefits and risks of adenosine administration should be carefully weighed, and the patient should be closely monitored for any adverse reactions 2.
From the Research
Consequences of Administering Adenosine to a Patient in Atrial Fibrillation (AFib)
- The administration of adenosine to a patient in atrial fibrillation (AFib) can have several consequences, including:
- Induction of ventricular fibrillation, as reported in a case study where a 26-year-old woman with no previous medical history developed coarse ventricular fibrillation and circulatory collapse after receiving a single intravenous dose of 6 mg adenosine 3.
- Pro-arrhythmic effects, such as asystole and polymorphic ventricular tachycardia, which were observed in 2% of patients in a study of adenosine use in hospitalized adults 4.
- Unmasking of dormant conduction in pulmonary veins, which can be used to guide additional ablation to improve arrhythmia-free survival in patients with paroxysmal AFib 5.
- The use of adenosine in patients with AFib is not always effective and may be associated with unnecessary expenses and risks of adverse effects, particularly if the diagnosis of AFib is incorrect 4.
- Adenosine is not typically used as a first-line treatment for AFib, and its use in this context is not well established, with some studies suggesting that catheter ablation may be a more effective treatment option for patients with treatment-naive AFib 6.
Safety and Efficacy of Adenosine in AFib
- Adenosine is generally considered safe and effective for the treatment of supraventricular tachycardia, but its use in AFib requires caution and careful consideration of the potential risks and benefits 3, 4.
- The safety and efficacy of adenosine in AFib have been evaluated in several studies, with mixed results, and further research is needed to fully understand its role in the treatment of this condition 4, 5, 6.
- Adenosine has been shown to be effective in unmasking dormant conduction in pulmonary veins and guiding additional ablation to improve arrhythmia-free survival in patients with paroxysmal AFib, but its use in this context is not widely established 5.