Abstract
Purpose: Adenosine is a useful agent for the diagnosis and termination of tachycardias.
The purpose of this study was to identify the rhythms for which adenosine is prescribed
in hospitalized adults and to identify the reasons for its misuse.
Patients and Methods: Data were collected from the medical records of 100 patients
who received intravenous adenosine while hospitalized at a university medical center.
The characteristics of the patients, rhythms treated with adenosine, and dosages of
adenosine were analyzed. In addition, internal medicine house officers were administered
a questionnaire referring to an electrocardiogram of atrial fibrillation with a rapid
ventricular response.
Results: The arrhythmias for which adenosine was administered consisted of regular,
narrow-QRS complex tachycardias in 33% of patients; atrial fibrillation in 32% of
patients; regular, wide-QRS complex tachycardias in 23% of patients; atrial flutter
in 10% of patients, and multifocal atrial tachycardia in 2% of patients. The mean
(± SD) number of doses of adenosine given to each patient was 1.6 ± 0.8, and the mean
dose of adenosine was 7.8 ± 2.8 mg. Internal medicine house officers prescribed 70%
of the doses of adenosine and were as likely to use it for patients with atrial fibrillation
as were surgical house officers. There was a 2% incidence of proarrhythmia, including
asystole and polymorphic ventricular tachycardia. Thirty-one percent of the 100 house
officers in our survey misdiagnosed a 12-lead electrocardiogram of rapid atrial fibrillation
as paroxysmal supraventricular tachycardia, suggesting that adenosine may have been
misused for atrial fibrillation because of errors in rhythm diagnosis. Only 5% of
those who correctly diagnosed atrial fibrillation also answered that adenosine would
be likely to terminate the arrhythmia, suggesting that a misunderstanding that adenosine
terminates atrial fibrillation is not a common reason for its misuse.
Conclusions: Approximately 40% of hospitalized adults who are treated with adenosine
receive the medication unnecessarily for atrial fibrillation or atrial flutter, and
this misuse results in unnecessary expenses and risks of adverse effects. The primary
reason that adenosine is misused for atrial fibrillation is the inability to recognize
that rhythm on an electrocardiogram. House officers need additional education on the
electrocardiographic recognition of atrial fibrillation.
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Article info
Publication history
Published online: August 16, 2004
Accepted:
May 27,
1998
Received in revised form:
May 27,
1998
Received:
February 4,
1998
Identification
Copyright
© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
