Adenosine is an endogenous nucleoside that is capable of causing atrioventricular block when administered in pharmacological concentrations. It has the considerable advantage of having an ultra-short plasma half-life of only a few seconds. Side-effects are usually transient, and include flushing, chest tightness, and bronchospasm, although sustained acceleration of atrial flutter from 2:1 to 1:1 atrioventricular conduction has been reported. Atrioventricular block may persist for several seconds. It has superseded verapamil as the agent of choice for the acute termination of junctional re-entrant arrhythmias. It is administered as an extremely rapid intravenous bolus of between 3 and 20 mg in an escalating regime until therapeutic or diagnostic effect has been noted ( Camm and Garratll991) (Fig 1).

Adenosine also has a role in the diagnosis of arrhythmias, particularly broad complex arrhythmias where the non-cardiologist may not easily distinguish ventricular tachycardia from supraventricular arrhythmias conducted with aberration.

Fig. 1 Termination of atrial tachycardia with 12 mg of intravenous adenosine. Note impaired atrioventricular conduction in beats after successful termination.

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