For the stable patient, adenosine should be used within the tachycardia algorithm when vagal maneuvers fail to terminate stable narrow-complex SVT. For the unstable patient with a regular and narrow QRS complex, adenosine may be considered prior to synchronized cardioversion.
Adenosine is the primary drug used in the treatment of stable narrow-complex SVT (Supraventricular Tachycardia). It can now also be used for regular monomorphic wide-complex tachycardia.
When given as a rapid IV bolus, adenosine slows cardiac conduction particularly affecting conduction through the AV node. The rapid bolus of adenosine also interrupts reentry (SVT causing) pathways through the AV node and restores sinus rhythm in patients with SVT.
When injected into the body, adenosine is rapidly absorbed by red blood cells and blood vessel endothelial cells and metabolized for natural uses throughout the body. In light of this adenosine should be administered by RAPID intravenous bolus so that a significant bolus of adenosine reaches the heart before it is metabolized.
A change from the 2010 guidelines now has adenosine given up to two times rather than three.
Dosing
The first dose of adenosine should be 6 mg administered rapidly over 1-3 seconds followed by a 20 ml NS bolus. If the patient’s rhythm does not convert out of SVT within 1 to 2 minutes, a second 12 mg dose may be given in similar fashion. All efforts should be made to administer adenosine as quickly as possible.
A lower initial dose of 3mg should be used for patients taking dipyridamole or carbamazepine as these two medications potentiate the effects of adenosine.
Also, prolonged asystole has been seen with the use of normal doses of adenosine in heart transplant patients and central line use. Therefore, the lower dose (3mg) may be considered for patients with a central venous line or a history of heart transplant.
Precautions
Some side effects of adenosine administration include flushing, chest pain/tightness, brief asystole or bradycardia.
Make sure that adenosine is not used for irregular, polymorphic wide-complex tachycardia and unstable VT. Use in these cases may cause clinical deterioration.
Harrell Guy Graham says
Will ATP work in this situation? Is the word ‘adenosine’ being used loosely to also refer to ATP? (I realize the two are distinct but I’ve seen researchers use the terms interchangeably when referring to treatments for certain tachycardias. Whereas the medicine used by doctors is labeled ‘Adenosine’)
Harrell Guy Graham says
Reason I am asking is because one patient swears to me he got “ATP” for his tachycardia.
Jeff with admin. says
ATP (adenosine triphosphate) is typically a reference to the organic chemical that is produced in biological systems and not the synthetic chemical typically labeled as adenosine that is structurally nearly identical to ATP.
There are molecular differences which I do not understand, but the patient would have received synthetic adenosine.
ATP would be a reference to the organic biologically produced chemical which is not available as a product. It is only produced within biological systems.
The person you were referring to was probably misinformed by someone like most of us who did not understand the chemical differences between ATP and adenosine.
Kind regards,
Jeff
See Thao says
Can adenosine be use on a patient example: came to the hosp for asthma exacerbation and then have a monomorphic ventricular tachycardia?
Jeff with admin. says
In the literature there are four case reports of patients with asthma or chronic obstructive airway disease developing bronchospasm following treatment with intravenous adenosine.
The case reports have their limitations and there is not a direct contraindication for the use of adenosine. However, care and caution should be used if a patient has any type of ongoing underlying condition that may affect the outcome of the administration of adenosine.
Kind regards,
Jeff
RAAZIZ says
Correct sir
Alvin Cachuela says
Adenosine is the primary drug used in the treatment of stable narrow-complex SVT (Supraventricular Tachycardia). It can now also be used for regular monomorphic wide-complex tachycardia. What does it means? does it means adenosine can be used for regular monomorphic VTACH? thanks
Jeff with admin. says
Yes that is correct. It can be used for regular monomorphic ventricular tachycardia with the pulse.
Kind regards,
Jeff
Richard says
I’ve had several SVT episodes – Two received EMS adenosine IV treatment and short ER visit – since then I’ve had several SVT events but have waited them out at home – is there any self-administered treatment that can be used? (like adenosine pill?)
Jeff with admin. says
SVT and its treatments can have serious side effects and should most likely be handled in the presence of healthcare professionals. I would encourage you to ask your provider the question you asked here.
Kind regards,
Jeff
Tracy says
I have a follow up question from Katharine. If adenosine was given to VT with a pulse in order to discern between VT & SVT, would the rhythm still go into asystole? OR would there be no effect at all– meaning, VT would remain on the monitor the whole time after adenosine administration?
Jeff with admin. says
Not always does the rhythm completely go to asystole. You will see a pause and then the rate will be much slower until the adenosine is metabolized over 30 to 60 seconds.
This is true for both VT and SVT.
Kind regards,
Jeff
Katharine says
Oh wait, you could give it for monomirphoc regular V Tach , too, I suppose.
Joel says
adenosine works by stopping AV nodal impulses. In ventricular tachycardia the impulse is from the ventricle. adenosine would have no effect on ventricular impulses. That is a shockable rhythm.