Adenosine induced ventricular fibrillation in a structurally normal heart: a case report

Area of Science:

• Cardiology
• Clinical Electrophysiology
• Pharmacology

Background:

• Adenosine is a primary treatment for supraventricular tachycardia, acting on the atrioventricular node.
• Pro-arrhythmic effects of adenosine are known, particularly with pre-excited atrial fibrillation.
• This case explores a rare adverse reaction to adenosine in a patient without structural heart disease.

Observation:

• A 26-year-old woman presented with palpitations and was treated with intravenous adenosine for narrow complex tachycardia.
• She rapidly developed ventricular fibrillation and circulatory collapse, requiring defibrillation and amiodarone.
• Extensive investigations, including electrophysiology study and cardiac MRI, ruled out accessory pathways and structural heart disease.

Findings:

• Adenosine administration induced ventricular fibrillation in a patient with no identifiable risk factors.
• This idiosyncratic reaction led to circulatory collapse.
• The patient's presenting rhythm was rapidly conducted atrial fibrillation without pre-excitation.

Implications:

• Adenosine is generally safe and effective for supraventricular tachycardia.
• Clinicians must be prepared for rare but severe adverse events like ventricular fibrillation.
• Availability of resuscitation and defibrillation equipment is essential during adenosine administration.