Adenosine for rapid a-fib?

  1. A week ago I had a surgical patient, s/p emergent rectal abscess I&D w/ a big cardiac history, post-op go into rapid a-fib 180's with low BP and SOB , the internal med doc in house had us give her adenosine 6 mg and then 12 mg. It didn't work, she didn't convert, and ended up in ICU on a cardizem and neo drip. What I'm wondering is, in the studying I'm doing right now to get ready for ACLS, I've come across several sources saying adenosine doesn't convert rapid a-fib. I'm still learning all these cardiac rhythms and meds, so I thought I'd ask on this forum, is adenosine commonly used for a-fib?
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    About grace90

    Joined: Jul '05; Posts: 778; Likes: 459
    Specialty: ortho/neuro/general surgery

    6 Comments

  3. by   EricJRN
    I've seen adenosine used before in situations where the rate was very rapid, but the doc or medic was thinking PSVT rather than atrial fib with RVR. I've never seen it work in those cases, but sometimes the rate slows down enough where they can identify that it's atrial fib and switch algorithms.
  4. by   jmgrn65
    It won't work, which you witnessed. I probably would have questioned him and maybe suggested to him cardizem or lopressor. Also it Adenosine isn't given fast enough then it work. Maybe like Eric said that he was thinking Svt instead.
  5. by   Dinith88
    Quote from grace90
    A week ago I had a surgical patient, s/p emergent rectal abscess I&D w/ a big cardiac history, post-op go into rapid a-fib 180's with low BP and SOB , the internal med doc in house had us give her adenosine 6 mg and then 12 mg. It didn't work, she didn't convert, and ended up in ICU on a cardizem and neo drip. What I'm wondering is, in the studying I'm doing right now to get ready for ACLS, I've come across several sources saying adenosine doesn't convert rapid a-fib. I'm still learning all these cardiac rhythms and meds, so I thought I'd ask on this forum, is adenosine commonly used for a-fib?
    when a rhythm starts going 180's, it's sometimes difficult to distinguish a-fib versus other SVT's (can sometimes 'look' regular at those rates). As the other posters mentioned it's sometimes a first-line med to rule out rhythms other than the a-fib. And yes, it can sometimes temporarily slow the rate down enough for a better 'look' at the rhythm.
  6. by   curlysin
    i have seen adenocine given many times in SVT but never AF. if i patient is clinically unstable like your patient was they should of immediately went for more aggressive treatment RE cardio coversion you have to obviously way up other numerous factors like length of time patient in AF, new presentation etc.i wouldnt have give the adenosine for a drug that causes that amount of distress to a patient and wouldnt warrent its use un-nessacarily. however being a member ACLS team makes me clinicaly experienced to make those kinds of clinical decision in that kind of situation.

    the problem possibly was the medical officer was unsure of the rythm as mentioned before it is hard to distinguish between and svt and a very rapid af. and in situations where the medical officer is unsure they go ahead an advise adenosine so they can slow down the rate long enough to confirm it. what they dont realise is if the actually take a deep breath and run a rythm strip they would be able to clarify the rythm without adenosine.

    for a very rapid af if the patient was haemodynamically stable would be treated with a beat blockade or amiodarone infusion

    if the patient has had a new presentation of AF and they are unsure for how long they have had it it is emensely dangerous to try and convert back to NSR therefore they must opt for rate control with say digoxin and either after and echo has confirmed no clotting in the chambers of the heart or at least six weeks post rate control can they warfrinise or DC convert. the risk of stroke if far far too high otherwise!!!

    hope this helped

    p.s i agree with dinith88.
    Last edit by curlysin on Aug 20, '06
  7. by   RGN1
    Quote from Dinith88
    when a rhythm starts going 180's, it's sometimes difficult to distinguish a-fib versus other SVT's (can sometimes 'look' regular at those rates). As the other posters mentioned it's sometimes a first-line med to rule out rhythms other than the a-fib. And yes, it can sometimes temporarily slow the rate down enough for a better 'look' at the rhythm.
    :yeahthat: I had a doc do exactly that on my acute med unit last year. Couldn't quite ID the reason behind the rapid rate so used adenosine to slow things down temporarily so she could see exactly what was going on. Worked a dream.
  8. by   SEOBowhntr
    I agree with these two statements.

    Quote from curlysin
    ....if i patient is clinically unstable like your patient was they should of immediately went for more aggressive treatment RE cardio coversion.

    AND

    take a deep breath and run a rythm strip they would be able to clarify the rhythm without adenosine.
    But in my clinical experience, everytime I've seen a doc order or push Adenosine, for a "suspected" SVT, I've just stood back and shook my head because it was easily identifiable as A-fib. Now when it's atrial flutter, esp. in a 2:1 block, that is when I'd consider using Adenosine. Anytime I've seen a Tachy-arrhythmia with any slight amount of irregularity, I shy away from Adenosine. Most patients I've given Adenosine to didn't like me after I'd pushed it because of how miserable it makes you feel, even if it doesn't convert the rhythm. If that patient ended up on a NEO and Cardizem gtt, I would suspect that either they were septic, or they had problems far beyond the initial I&D.

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