can adenosine cause asystole??

on friday,i had a horrific experience at the hospital. i suffer from atrial fibrillation and it was very bad,i called my cardiologist and he suggested i had a chemical cardioversion with adenosine. i was scared of electric cardioversions,so i decided to go ahead and do it. i took some valium to calm my nerves and the cardio. assured me that they do these all the time and for me to be calm. i remember lying down,the nurse asked me when to inject the IV and i said i'm good..then,i swear,it was the most horrific thing i ever experienced..my ears started to ring and just like that,i completly blacked out. the next thing that i remembered was lying in a different room with a different nurse. i was actually in the ICU. thanfully i had no brain damage but i was so confused,finally my cardiologist came in and told me what happened. for some reason my heart did not take well to the adenosine and i actually went into asystole for 30 whole seconds. he told me that they quickly gave me an atropine IV and i opened my eyes..i do not remember any of that. they took me to the ICU for observation and i just got back home. i am now so damn scared,i will never go to the hospital even in the worst cases of A-fib. can anyone here tell me why i went into asystole?? is there anything else i can do when i get another bad episode of A-fib? i am still freaked out! please give me some answers,thanks!!

[CFS56]

I really can't answer your question but I do know that reactions like you had are very rare.  Adenosine has a half life of 1 to 6 seconds, so it's out of your system very quickly.  But honestly, I have never heard of it being used to convert atrial fib.  When I have gone to the ER in atrial fib,  they have given me a calcium channel blocker to control the ventricular rate and once they had to give me sotolol for the atrial fib.  Adenosine to my knowledge is only used in SVT.

[CFS56]

I just looked adenosine up and it specifically states that it is not effective in converting anything but PSVT to normal sinuse rhythm that it does not work with atrial fib or flutter.

[justanumber]

i should mention that i have bad cases of A-fib with rapid ventricular response. my cardiologist said that he had many patients with this specific condition that adenosine really helped get the rhythm down. my heart gets up to 185 bpm's. i was observed and had lots of tests done in the ICU and the doctors think it was a vagal nerve response. my brain checked out fine but i absolutely forgot a full hour of what happened to me after my initial reaction. i mentioned before that i am scared of electro cardioversions and now i had this horrible side effect. i take beta blockers but they do not help these bad cases..can anyone here please tell me what to do if/when another bad case happens? i am not scared to go to the hospital.

[is_something_wrong]

I didn't know they converved A-fib with adenosine. This medication works specificly on the sinus node and AV node, so I wouldn't think it would help converting A-fib. They usually use electroconversion or a short acting antiarrhythmic drug (usually ibutilide) or a longer acting substance (flecainide, sotalol or amiodarone).

Adenosine is used to convert arrhythmias involving the AV node (av nodal reentry tachycardia or in some cases av reentry tachycardia) also known as "PSVT".

Yes, adenosine will cause asystole, but not for half a minute. The fact that your heart didn't produce a ventricular escape rhythm is also strange (most hearts will not be able to stand still for half a minute).

[itdood]

I would want to know what rhythm caused the 30 second asystole.    Was it v-tach?  was it course-vib?

I'm an anxious type and I would much rather have the electro-cardioversion.  Just for the reasons you just found out.  In the states, they usually give the patient Propofol (a.k.a. "milk of amnesia") before zapping you.    You won't remember a darn thing.  I had propofol for an upper GI once, it was nice!

is_something_wrong, it could have been pulse-less v-tach?  perhaps an escape beat that went into VT.

[LindaTX]

I feel for you, justanumber.  A few years ago I was at a hospital in Alaska doing a treadmill stress test.  They stopped it when I went into a-fib, then they gave me adenosine and that threw me into v-tach.  I ended up spending the next few days in ICU.

Then about 6 weeks ago I went to the ER for a bout of atrial tachycardia that I couldn't convert out of.  They gave me adenosine and I went momentarily into 3rd degree block.  They opted not to give me any more adenosine.  Still don't know the hows or whys of it.  I just know I don't ever want any more adenosine

[CFS56]

I can not understand the adenosine for A fib.  Being the questioning big mouth that I am I would definitely ask why.

[DeltaDawn23]

I would not be afraid of electro-conversion.  It sounds scary, but you're sedated, know nothing about it, and it just takes a few seconds.  I had electro-conversions this year and it snapped me right back into a normal  rhythm. Are you taking anything for the Afib?  Beta blockers and Xanax worked for me for 8 years. I just added an anti-arrhythmic this spring and coumadin.  I would ask what your options are to keep you out of Afib.  Are you avoiding caffeine and getting enough sleep?  Sometimes some lifestyle changes will make a huge difference.  Good luck . . . keeping you in my thoughts.    

[DeltaDawn23]

A couple of other thoughts -- I had Adenosine in a test on a treadmill once and it nearly knocked me to my knees.  I couldn't keep going.

Perhaps a second opinion for a treatment plan is in order?

[LindaTX]

I've never been electro-cardioverted (just a scaredy-cat, I guess) but I think Delta Dawn has a point, sounds like it might beat the alternative. I know, different drugs for different people but adenosine is out for me.

CFS56, sometimes when you're in the hospital you don't always have the wherewithall to ask the most pertinent questions.  When you're in the ER and they are wanting to chemically-convert you, you think they know what's best to do at the moment.  I'm not one to go running to the ER.  What I've noticed is the last couple of times I've had to make that call, they don't want you to come in and wait for you to convert on your own.  The new protocol is do something proactive as soon as you come in....even if it turns out to be WRONG!