USE OF ADENOSINE IN PATIENTS HOSPITALIZED IN A UNIVERSITY MEDICAL-CENTER

PURPOSE: Adenosine is a useful agent for the diagnosis and termination of tachycardias. The purpose of this study was to identify the rhythm s for which adenosine is prescribed in hospitalized adults and to iden tify the reasons for its misuse. PATIENTS AND METHODS: Data were colle cted from the medical records of 100 patients who received intravenous adenosine while hospitalized at a university medical center. The char acteristics of the patients, rhythms treated with adenosine, and dosag es of adenosine were analyzed. In addition, internal medicine house of ficers were administered a questionnaire referring to an electrocardio gram of atrial fibrillation with a rapid ventricular response. RESULTS : The arrhythmias for which adenosine was administered consisted of re gular, narrow-QRS complex tachycardias in 33% of patients; atrial fibr illation in 32% of patients; regular, wide-QRS complex tachycardias in 23% of patients; atrial flutter in 10% of patients, and multifocal at rial tachycardia in 2% of patients. The mean (+/- SD) number of doses of adenosine given to each patient tvas 1.6 +/- 0.8, and the mean dose of adenosine was 7.8 +/- 2.8 mg. Internal medicine house officers pre scribed 70% of the doses of adenosine and were as likely to use it for patients with atrial fibrillation as were surgical house officers. Th ere was a 2% incidence of proarrhythmia, including asystole and polymo rphic ventricular tachycardia. Thirty-one percent of the 100 house off icers in our survey misdiagnosed a 12-lead electrocardiogram of rapid atrial fibrillation as paroxysmal supraventricular tachycardia, sugges ting that adenosine may have been misused for atrial fibrillation beca use of errors in rhythm diagnosis. Only 5% of those who correctly diag nosed atrial fibrillation also answered that adenosine would be likely to terminate the arrhythmia, suggesting that a misunderstanding that adenosine terminates atrial fibrillation is not a common reason for it s misuse. CONCLUSIONS: Approximately 40% of hospitalized adults who ar e treated with adenosine receive the medication unnecessarily for atri al fibrillation or atrial flutter, and this misuse results in unnecess ary expenses and risks of adverse effects. The primary reason that ade nosine is misused for atrial fibrillation is the inability to recogniz e that rhythm on an electrocardiogram. House officers need additional education on the electrocardiographic recognition of atrial fibrillati on. (C) 1998 by Excerpta Medica, Inc.