How to Induce Arrhythmias with Salbutamol

  • Piotr Futyma


Salbutamol is a selective beta2 adrenoreceptor agonist causing bronchodilation. It is commonly used for the treatment of acute bronchoconstriction episodes such as acute asthmatic crisis or status asthmaticus. It is also used for treatment of chronic obstructive pulmonary disease. As a β2 selective agonist, intravenous salbutamol may also serve as a pharmacologic agent for the induction of arrhythmias during electrophysiological study (EPS). Infusion of salbutamol significantly shortens sinus node cycle length and sinus node recovery time. It also shortens effective refractory period of the AV node, significantly shortens AH interval and the Wenckebach point (WP), and decreases atrial and ventricular effective refractory periods. Doses used in the setting of EPS differ from those used during acute asthmatic crisis. A recommended single bolus dose for use in the EP lab equals 0.125 mg of salbutamol.


  1. 1.
    Davis E, Loiacono R, Summers RJ. The rush to adrenaline: drugs in sport acting on the β-adrenergic system. Br J Pharmacol. 2008;154(3):584–97.CrossRefGoogle Scholar
  2. 2.
    Cekici L, Valipour A, Kohansal R, Burghuber OC. Short-term effects of inhaled salbutamol on autonomic cardiovascular control in healthy subjects: a placebo-controlled study. Br J Clin Pharmacol. 2009;67(4):394–402.CrossRefGoogle Scholar
  3. 3.
    Selective beta2 agonists—side effects. British National Formulary. 57 ed. London: BMJ Publishing Group Ltd and Royal Pharmaceutical Society Publishing; 2008. ISBN 0-85369-778-7.Google Scholar
  4. 4.
    Lowe MD, Rowland E, Brown MJ, Grace AA. Beta(2) adrenergic receptors mediate important electrophysiological effects in human ventricular myocardium. Heart. 2001;86(1):45–51.CrossRefGoogle Scholar
  5. 5.
    Insulander P, Juhlin-Dannfelt A, Freyschuss U, Valln H. Electrophysiologic effects of Salbutamol a beta 2 selective agonist. J Cardiovasc Electrophysiol. 2004;15:316–22.CrossRefGoogle Scholar
  6. 6.
    Rodefeld MD, Beau SL, Schuessler RB, et al. Betaadrenergic and muscarinic cholinergic receptor densities in the human sinoatrial node identification of a high beta 2 adrenergic receptor density. J Cardiovasc Electrophysiol. 1996;7:1039–49.CrossRefGoogle Scholar
  7. 7.
    Summers RJ, Molnaar P, Russel F, Elnatan J, Jones CR, Buxton BF, Chang V, Hmbley J. Coexistence and localization of beta 1 and beta 2 adrenoreceptors in the human heart. Eur Heart J. 1989;10:11–21.CrossRefGoogle Scholar
  8. 8.
    Kallergs EM, Manios EG, Kanoupakis EM, Schiza SE, Mavrakis HE, Klapsinos NK, et al. Acute electrophysiologic effects of inhaled salbutamol in humans. Chest. 2005;127:2057–63.CrossRefGoogle Scholar
  9. 9.
    Al-Hillawi AH. Incidence of cardiac arrhythmias in patients taking slow release salbutamol and terbutaline for asthma. Br Med J. 1984;287:863–7.CrossRefGoogle Scholar
  10. 10.
    Trachsel D, Newth CJL, Hammer J. Adenosine for salbutamol-induced supraventricular tachycardia. Intensive Care Med. 2007;22:1676.CrossRefGoogle Scholar
  11. 11.
    Duane M, Chandran L, Morelli PJ. Recurrent supraventricular tachycardia as a complication of nebulized albuterol treatment. Clin Pediatr (Phila). 2000;39(11):673–7.CrossRefGoogle Scholar
  12. 12.
    Keller KA, Bhisitkul DM. Supraventricular tachycardia: a complication of nebulized albuterol. Pediatr Emerg Care. 1995;11:98–9.CrossRefGoogle Scholar
  13. 13.
    Cook P, Scarfone RJ, Cook RT. Adenosine in the termination of albuterol-induced supraventricular tachycardia. Ann Emerg Med. 1994;24:316–9.CrossRefGoogle Scholar
  14. 14.
    Say B, Degirmencioglu H, Kutman HGK, Uras N, Dilmen U. Taquicardia supraventricular en un recien nacido despues del tratamiento con salbutamol nebulizado. A proposito de un caso. Arch Argent Pediatr. 2015;113:e98–100.PubMedGoogle Scholar
  15. 15.
    Kroesen M, Maseland M, Smal J, Reimer A, van Setten P. Probable association of achyarrhythmia with nebulized albuterol in a child with previously subclinical wolff Parkinson White syndrome. J Pediatr Pharmacol Ther. 2012;17:93–7.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Bonnin AJ, Richmond GW, Musto PK, Volgman AS, Moy JN. Repeated inhalation of nebulized albuterol did not induce arrhythmias in a patient with Wolff-Parkinosn-White syndrome and asthma. Chest. 1993;103:1892–4.CrossRefGoogle Scholar
  17. 17.
    Tandeter H, Kobal S, Katz A. Swallowing-induced atrial tachyarrhythmia triggered by salbutamol: case report and review of the literature. ClinCardiol. 2010;33(6):E116–20.Google Scholar
  18. 18.
    Uysal E, Solak S, Carus M, Uzun N, Cevik E. Salbutamol abuse is associated with ventricular fibrillation. Turk J Emerg Med. 2015;15:87–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Piotr Futyma
    • 1
  1. 1.Invasive Cardiology DepartmentSt. Joseph’s Heart CenterRzeszowPoland

Personalised recommendations