• Adenosine temporarily blocks conduction through the AV node. If a supraventricular tachycardia (usually narrow but wide if there is aberrance) involves re-entry within or through the AV node, adenosine can break the circuit, converting the arrhythmia to sinus rhythm. In the absence of a re-entry mechanism, adenosine stops the ventricles for a few seconds, allowing identification of an atrial arrhythmia.

• The period of ventricular standstill can be alarming for both staff and patient.

• Cardiac monitoring is mandatory and facilities for recording the ECG should be available.

• Side-effects are transient but unpleasant and include chest pain and hot flushes. Patients should be warned in advance.

• The dose is 3mg, 6mg, then 12 mg, repeated as necessary.

• Rapid administration followed by a large flush is necessary.

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