Adenosine use in WPW

[mobey]

So I am reading quite heavily on this and could use a little coaching.

If Adenosine (Adenocard) suppresses AV nodal conduction, why would you give it to someone with an accessory pathway such as WPW? Would that not just encourage the heart to use the accessory pathway as the main gateway and sustain the tachycardia?

[chbare]

Yes, you have a valid concern. While adenosine can interrupt accessory pathways, if you decide to use adenosine, you need to anticipate additional problems.

Take care,

chbare.

[mobey]

Yes, you have a valid concern. While adenosine can interrupt accessory pathways, if you decide to use adenosine, you need to anticipate additional problems.

Take care,

chbare.

hmmm..... kinda makes me want to just cardiovert... or if fairly stable, move to amiodarone or diltiazem.

And yes..... it is 2hrs since my post above......and ya, I am still reading lol

Edited August 16, 2009 by mobey

[EMS49393]

Procainamide is the anti-arrhythmic of choice for WPW, both diltiazem and amiodarone are contraindicated.

[mobey]

Procainamide is the anti-arrhythmic of choice for WPW, both diltiazem and amiodarone are contraindicated.

That depends on your source.

I am discussing/reasearching pathophysiology and pharmocology related to WPW, not so much local protocols related to it.

[EMS49393]

It's not a local protocol. My service doesn't even carry procainamide or amiodarone. My knowledge about WPW is from both education and research.

My bad for attempting to share what I know. I now know that next time I want to offer help here I'll just shut up, read, and snicker to myself.

[spenac]

Procainamide is the anti-arrhythmic of choice for WPW, both diltiazem and amiodarone are contraindicated.

Can you please provide reference as I show in my research that either Procainamide or Amiodarone can be used with WPW.

I also show that you avoid Adenosine, Beta Blockers, Calcium channel blockers, Digoxin.

Thanks for the help.

[akroeze]

My bad for attempting to share what I know. I now know that next time I want to offer help here I'll just shut up, read, and snicker to myself.

Wow, sensitive and over react much?

[tniuqs]

That depends on your source.

I am discussing/reasearching pathophysiology and pharmocology related to WPW, not so much local protocols related to it.

Just some anecdotal comments when they are unstable ... many tolerate WPW and will tell you that is there issue.

ASK the patient how they have been treated before ... 4 out of 5 that I have treated astoundly would prefer Cardioversion to Adenosine .... go figure.

And yea my books are confusing too.

[chbare]

Yeah, I am a bit confused over taking a comment personally. Sometimes people call you out when you state something as a fact. Should not be a problem. However, some sources state that procainamide is an agent to consider. A few emedicine articles discuss this medication. It is also true that sources consider amiodarone.

The truth is, WPW is complicated to treat medically,and cardioversion may be the best route in many patients. WPW treatment ( with chemisty ) can be even more complex if an arrhythmia such as atrial fibrillation is present.

Take care,

chbare.