Safety and tolerability of adenosine
Despite very widespread use in an emergency-room setting for the acute
management of supraventricular tachycardia, there are very few reports
of significant adverse effects and none in a meta-analysis of randomised
trials.15 Unfortunately it produces unpleasant chest
tightness in most patients, tolerable as a single experience but
increasingly unpleasant with repetition. This makes a single bolus
preferable to a regime of escalating doses. The single-dose 10mg
protocol used in this series was tolerated without difficulty by all
patients who received just light sedation. As PVI is generally performed
under general anaesthesia or deeper sedation, higher doses of adenosine
or escalating dosage regimes are easily tolerated.