Adenosine and ventricular fibrillation

Adenosine and ventricular fibrillation

Adenosine and ventricular fibrillation has been reported in two situations:

  1. During intracoronary administration for assessment of fractional flow reserve (FFR)
  2. Intravenous administration in an attempt to identify the mechanism of wide QRS tachycardia

Adenosine induced ventricular fibrillation during FFR estimation

Three cases of ventricular fibrillation (VF) during intracoronary administration for induction of maximal hyperemia was observed by Shah AH et al [1]. They could prevent future occurrences by doubling the concentration in order to reduce the volume of injection by half.
Similar instance of adenosine induced VF during FFR assessment has been reported by Khan ZA et al in a single case [2].

Adenosine induced VF after administration in an attempt to identify the mechanism of wide QRS tachycardia

Several cases of adenosine induced VF when given for supraventricular tachycardia or atrial fibrillation have been reported [3-5].
Gupta AK and colleagues reported 4 cases of VF after administration of 12 mg adenosine in preexcited atrial fibrillation which had presented as wide QRS tachycardia [6]. They noted that this phenomenon occurred in accessory pathways with a short refractory period.
Parham WA and associates reported adenosine induced VF in a patient with stable ventricular tachycardia [7]. Adenosine had been administered as a therapeutic challenge in a wide QRS tachycardia of uncertain nature. It was later proved to be ventricular tachycardia at electrophysiological study.

References

  1. Shah AH, Chan W, Seidelin PH. Ventricular Fibrillation Precipitated by Intracoronary Adenosine During Fractional Flow Reserve Assessment – A Cautionary Tale.Heart Lung Circ. 2015 Nov;24(11):e173-5.
  2. Khan ZA, Akbar G, Saeed W, Malik S, Khan F, Sardar MR. Ventricular fibrillation with intracoronary adenosine during fractional flow reserve assessment. Cardiovasc Revasc Med. 2016 Jul 20. [Epub ahead of print]
  3. Ben-Sorek ES, Wiesel J. Ventricular fibrillation following adenosine administration. A case report. Arch Intern Med. 1993 Dec 13;153(23):2701-2.
  4. Pella J, Stancák B, Komanová E, Novotný R. Ventricular fibrillation after administration of adenosine.Vnitr Lek. 1995 Dec;41(12):832-5.
  5. Mulla N, Karpawich PP. Ventricular fibrillation following adenosine therapy for supraventricular tachycardia in a neonate with concealed Wolff-Parkinson-White syndrome treated with digoxin. Pediatr Emerg Care. 1995 Aug;11(4):238-9.
  6. Gupta AK, Shah CP, Maheshwari A, Thakur RK, Hayes OW, Lokhandwala YY. Adenosine induced ventricular fibrillation in Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol. 2002 Apr;25(4 Pt 1):477-80.
  7. Parham WA, Mehdirad AA, Biermann KM, Fredman CS. Case report: adenosine induced ventricular fibrillation in a patient with stable ventricular tachycardia. J Interv Card Electrophysiol. 2001 Mar;5(1):71-4.

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