Intravenous adenosine for stable supraventricular tachycardia can rarely cause a paradoxical surge of tachycardia with hemodynamic compromise.
Vigilance needed for rare paradoxical tachycardia after adenosine in SVT; single case leaves open incidence and mechanisms.
An approximately 20-year-old to 30-year-old patient presented with a haemodynamically stable supraventricular tachycardia . The patient was managed with intravenous adenosine primarily, with two bolus doses of 6 and 12 mg. This, however, caused a rare paradoxical surge of tachycardia with mild haemodynamic compromise. The patient further required a combination of Metoprolol and Verapamil administration to slow down and reverse the arrhythmia. Following this the patient remained stable with no further episodes till discharge.
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Kunnumpuram et al. (2012) studied this question.
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