Utility of adenosine administration during intraoperative mapping in a patient with the Wolff-Parkinson-White...

Adenosine is an endogenous nucleoside that is administered intravenously and has potent chronotropic and dromotropic effects. This drug is distinguished from verapamil by its very short half-life. This makes it an ideal agent for use in the operating room where long lasting electrophysiological effects may not be desirable. A 61-year-old man with preexcited atrial fibrillation was referred for surgical ablation of his accessory pathway. Preexcitation was minimal or absent on arrival in the operating room. Intravenous adenosine was given causing AV nodal block, and resulted in marked preexcitation, thus allowing computerized mapping to localize the site of the accessory pathway. Adenosine may be a useful agent for rapid and precise localization of accessory pathway(s) in a select group of patients with minimal preexcitation at the time of surgery. Its short half-life allows additional mapping without sustained electrophysiological effects on the AV node, or accessory pathway.