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> Not my experience at all. I only see about 30% revert with > adenosine. I tend to ask for > cardioversion rather than verapamil as the next step. > That's a problem with the protocol. The protocol gives a maximum dose of 12 mg of adenosine. This is based on studies giving adenosine via a central line. The first time I came across the ERC SVT protocol it was presented by Professor Chamberlain who admitted he goes up well beyond the 12 mg despite having written a protocol so limiting the dose. > If there is transient AV block with specific ECG changes > (characteristic > P waves, flutter, or fibrillation waves) the arrhythmia is > likely to be > atrial tachycardia, flutter, or fibrillation. Mind you, you should be able to pick up MAT or AF clinically. > As a side issue asthma is a contra-indication/or cautioned. Due to its > short half life, it is probably still quite safe?is there > much evidence > for catastrophy from using adenosine in asthmatics. This comes from IV infusions of adenosine which used to be given for various purposes. Not come across any reports of problems from a stat dose. In theory this would be an (the sole?) indication for IV methyxanthines in asthma as they are direct adenosine antagonists; although in practice the adenosine would be metabolised before you could draw up the infusion. The BestBets may have missed the papers around by using the wrong search strategy (if looking for complications of a drug a lot of papers can be missed if you restrict your search to that drug being used for a particular indication) > I don't know whether or not he was unstable. I'd hope he was stable. Transferring a haemodynamically unstable World Leader from Aylesbury to London for a procedure that could easily have been carried out at the primary hospital is not recommended SOP. > If unstable of > course cardioversion makes sense, however, if he is stable > I'm not sure I would proceed with cardioversion as this as my > first line therapy. First of all it is quite painful. Also it > is my understanding that there is risk of CVA involved in > converting someone into sinus rhythm before anticoagulation, > and that the goal of therapy is control of the ventricular > rate. Risk of conversion before anticoagulation is mainly in AF of a few days' duration. No risk in SVT. Safe if AF of new onset (in the last few hours). However, in an otherwise well patient there's a lot to be said for doing nothing for AF- most revert within 24 hours; and most that don't will go back into AF if you do cardiovert. The pendulum is certainly swinging towards rate control rather than cardioversion for most AFs though. If I was looking at cardioversion in AF, I'd consider chemical cardioversion. Matt Dunn Warwick This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error, please notify the sender.