Adenosine dosage and administration
In a landmark evaluation of the electrophysiological effects of adenosine, DiMarco et al.11 showed that the production of AV block required a mean dosage of 179 + 88 µg/kg. When used to terminate supraventricular tachycardias, adenosine is given by rapid intravenous injection, typically through a cannula in a peripheral vein at an initial dosage of 6mg, progressing in steps to a maximum of 18mg.12 Testing for dormant conduction after pulmonary vein isolation predicts reconnection and facilitates the achievement of permanent block.13 A range of adenosine dosages has been applied, mostly in the range of 12-30mg. In many cases, an initial dose of 12mg was followed by higher doses if atrioventricular block was not produced initially, but Kumagai et al used a dosage regime equivalent to ours.14
A previous evaluation of adenosine testing after CTI ablation by Morales et al9 using a dosage of 0.2mg/kg with a minimum of 12mg administered immediately after achievement of CTI block recorded a false negative rate of 1.2% in predicting durability of block to 30 minutes.