Why the study?
To alert emergency physicians about the potential life-threatening complications associated with supraventricular tachycardia and its reversal with adenosine in a structurally normal heart.
Adenosine administration for supraventricular tachycardia can rarely precipitate life-threatening complications such as torsades de pointes and acute myocardial infarction, likely due to coronary vasospasm.
Highlights need for caution with adenosine in SVT; leaves open incidence of rare adverse events.
Adenosine is an antiarrhythmic drug that slows conduction through the atrioventricular node and acts as a coronary blood vessel dilator. This case report highlights two unusual life-threatening events following the use of adenosine to revert supraventricular tachycardia in a structurally normal heart: non-sustained polymorphic ventricular tachycardia and myocardial infarction. A 46-year-old woman presented to the emergency department with a two-hour history of palpitations and was diagnosed with supraventricular tachycardia. Vagal maneuvers were ineffective, and after intravenous adenosine administration, the patient presented with chest pain and hypotension. The rhythm degenerated into non-sustained polymorphic ventricular tachycardia and spontaneously reverted to sinus rhythm with ST elevation in lead aVR and ST depression in the inferior and anterolateral leads. The patient spontaneously recovered within a few minutes. Despite successful arrhythmia reversal, the patient was admitted to the intensive care unit because of an infarction without obstructive atherosclerosis. This report aims to alert emergency physicians about the potential complications associated with supraventricular tachycardia and its reversal with adenosine.
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Paixão et al. (2024) studied this question.
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