ADENOSIN. NOTFALLTHERAPIE VON PAROXYSMALEN SUPRAVENTRIKULAREN TACHYKARDIEN

Adenosine, and endogenous nucleoside, reduces atrioventricular nodal conduction time and terminates paroxysmal supraventricular tachycardia (PSVT), if the atrioventricular node is part of the reentrant circuit. The dose-dependent effects of adenosine are characterized by a rapid onset, a high efficacy and a low incidence of side effects due to its very short half-life. Its safe use has been demonstrated in adults, children, and during pregnancy. The efficacy of adenosine is similar to that of verapamil. Adverse reactions are minor and shorter. In the unstable patient with PVST, adenosine treatment appears to be an alternative to electrical cardioversion. Adenosine is ineffective in terminating sinus tachycardia, atrial tachycardia or atrial fibrillation and ventricular tachycardia, but production of a transient bidirectional AV block may help to find the correct diagnosis. Serious complications, though rare, may occur in patients with cardiac conduction defects (e.g. sick-sinus-syndrome, AV block, prolonged QT syndrome). Therefore continuous ECG monitoring and electrotherapy should be available under prehospital conditions. Adenosine appears to be the drug of choice in the emergency management of paroxysmal narrow-complex tachycardia.