J Korean Soc Emerg Med.  2004 Oct;15(5):331-336.

Clinical Review of Inappropriate Use of Adenosine in Tachycardic Patients at the Emergency Department

• Sinn DH
• Song KJ
• Shin BS
• Choi PC

Abstract

PURPOSE
For tachycardic patients not in need of immediate cardioversion, the International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care emphasize specific rhythm diagnosis and avoidance of simplistic overuse of adenosine. The purpose of this study was to identify the rhythms for which adenosine was inappropriately prescribed at the emergency department after the International Guidelines 2000 had been adopted.
METHODS
We retrospectively investigated 128 tachycardic patients who had been prescribed adenosine at the emergency department from September 2000 to March 2003. Patients were divided into two groups. The Appropriate Use Group was comprised of patients for whom had been prescribed for narrow QRS-complex tachycardia on the initial ECG. The Inappropriate Use Group was comprised of patients for whom adenosine had been prescribed for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin on the initial ECG.
RESULTS
Of the 128 patients, 31 (24.2%) were in the Inappropriate Use Group. Among them, atrial fibrillation was involved in 15, atrial flutter in 3, atrial tachycardia in 2, sinus tachycardia in 8, and wide QRS-complex tachycardia of unknown origin in 3.
CONCLUSION
Approximately 24% of the emergency department patients who were treated with adenosine received the medication unnecessarily for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin. Additional education on electrocardiographic recognition of tachyarrhythmias, and the Tachycardia Algorithms of Guidelines 2000 may be necessary for residents of emergency department.

Keyword

Adenosine; Tachycardia

MeSH Terms

Adenosine*
Atrial Fibrillation
Atrial Flutter
Cardiopulmonary Resuscitation
Diagnosis
Education
Electric Countershock
Electrocardiography
Emergencies*
Emergency Service, Hospital*
Humans
Retrospective Studies
Tachycardia
Tachycardia, Sinus
Adenosine