Limitations of adenosine testing
The rate of long term clinical cure of atrial flutter in most modern series, including the current one exceeds 98%. This context makes the observed failure rate of early adenosine testing of 2.3% in our series and the 1.2% failure rate recorded by Morales et al highly significant. With such a high rate success easily available, acceptance of anything less than certainty in the permanence of block would be unsatisfactory. The regime that we used does not meet this standard; a higher dosage, or a dosage regime tailored to the patient’s weight or to the effect on atrioventricular conduction would be worth evaluating.