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.