Adenosine-induced atrial pro-arrhythmia in children

Area of Science:

• Cardiology
• Pediatric Electrophysiology
• Pharmacology

Background:

• Adenosine is a first-line pharmacologic agent for the acute management of supraventricular tachycardias (SVT).
• Its use is generally associated with a favorable safety profile in adult populations.
• Previous reports have documented serious proarrhythmic events, including atrial fibrillation, in adults.

Observation:

• Three pediatric cases of adenosine-induced atrial proarrhythmia were observed at the Hospital for Sick Children, Toronto.
• These events included two cases of atrial fibrillation and one case of atrial flutter.
• All pediatric patients had manifest or concealed Wolff-Parkinson-White syndrome.

Findings:

• Adenosine administration can precipitate atrial arrhythmias in pediatric patients with Wolff-Parkinson-White syndrome.
• The drug may enhance antegrade conduction through bypass tracts.
• This can lead to ventricular acceleration and potentially ventricular fibrillation.

Implications:

• This study highlights a previously unreported risk of atrial arrhythmia associated with adenosine use in children.
• Clinicians should exercise caution and implement appropriate monitoring during adenosine administration in pediatric patients.
• Enhanced vigilance is necessary for both pediatric and adult patients receiving adenosine, particularly those with pre-existing cardiac conditions.