Adenosine-induced atrial proarrhythmia in children

Adenosine has became the preferred acute treatment for common types of supr aventricular tachycardia because of its efficacy and safety. There have bee n a few reports of serious proarrhythmic events associated with its use, in cluding the induction of atrial fibrillation in adult patients. Three insta nces of adenosine-induced atrial proarrhythmia (two aerial fibrillation and one atrial flutter) have been observed in children with manifest or concea led Wolff-Parkinson-White syndrome at the Hospital for Sick Children, Toron to, Ontario since 1990, which indicates a previously unreported risk of atr ial arrhythmia for children as well. Because adenosine may enhance antegrad e bypass tract conduction, its use carries a risk of ventricular accelerati on, including progression eo ventricular fibrillation. Because of such rare and potentially life threatening adverse effects, appropriate monitoring a nd precautions are required during the administration of the drug to childr en and adults.