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The ECG during symptoms was strongly suggestive of typical atrial flutter. After adenosine administration, the heart rate slowed for a few seconds because of 3:1 atrioventricular (AV) conduction, but it then changed to 1:1 conduction response (Fig. 1). This was associated with haemodynamic instability, which required electrocardioversion. Although adenosine administration is usually innocuous, its potential harmful effects should not be underestimated. A careful analysis of the initial ECG could have foreseen this atypical response, as 1:1 AV conduction beats were observed [1]. These beats are indicators of a high sympathetic tone, which increased after adenosine administration, with the outcome described above [2]. This case shows the unusual but dangerous proarrhythmic effect of adenosine in patients with atrial flutter, after producing important sympathetic discharge and subsequent 1:1 AV conduction, as well as the presence of predictors in the ECG which discourage its administration [3].
Conclusion
Atrial flutter with 1:1 atrioventricular conduction after administration of adenosine.
References
Slade AK, Garratt CJ. Proarrhythmic effect of adenosine in a patient with atrial flutter. Br Heart J. 1993;70:91–2.
Rotondi F, Lanzillo T, Manganelli F, et al. Atypical response of class IC atrial flutter to adenosine. Monaldi Arch Chest Dis. 2011;76:151–4.
Mallet ML. Proarrhythmic effects of adenosine: a review of the literature. Emerg Med J. 2004;21:408–10.
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P. Robles Velasco, I. Monedero Sánchez, A. Rubio Caballero, M. Chichakli Cela and Y. González Doforno declare that they have no competing interests.
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Robles Velasco, P., Monedero Sánchez, I., Rubio Caballero, A. et al. Adenosine administration in supraventricular tachycardia. Neth Heart J 26, 221–222 (2018). https://doi.org/10.1007/s12471-017-1033-9
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DOI: https://doi.org/10.1007/s12471-017-1033-9