Complete heart block associated with regadenoson: A real side effect
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From the Division of Cardiovascular Diseases, Mayo Clinic in Arizona, Scottsdale, AZ. Received for publication Jul 5, 2012; final revision accepted Jul 19, 2012; final revision accepted Jul 29, 2012. Reprint requests: Anil Pandit, MBBS, Division of Cardiovascular Diseases, Mayo Clinic in Arizona, 13400 E Shea Blvd., Scottsdale, AZ 85259; [email protected]. J Nucl Cardiol 2012;19:1236–9. 1071-3581/$34.00 Copyright Ó 2012 American Society of Nuclear Cardiology. doi:10.1007/s12350-012-9610-1 1236
degree AV block (Figure 2) which progressed to a thirddegree AV block (Figure 3) which was immediately reversed with aminophylline (Figure 4). The patient remained asymptomatic during the episode. The perfusion scan as well as the left ventricular function was normal.
DISCUSSION We performed an extensive review of animal studies and clinical trials in humans and failed to find a case of complete heart block with administration of regadenoson.1,2 The review of the Food and Drug Adminstration (FDA) database documents at least 8 cases of complete heart block due to regadenoson in post-marketing surveillance.3 Previous cases have not described whether the patients had renal dysfunction or not. It is our observation and others that regadenoson does produce more symptoms to ESRD patients than it does to other populations. It is impossible to predict which patient with a normal ECG will develop a complete heart block, stressing the importance of recognizing potential side effects and treating them immediately.
Journal of Nuclear Cardiology Volume 19, Number 6;1236–9
Pandit and Unzek Freiman Complete heart block associated with regadenoson
Figure 1. Normal sinus rhythm with normal PR interval and no ST abnormalities on the patient who underwent vasodilator stress test with regadenoson.
Figure 2. At approximately 1.3 minutes into the recovery, the patient developed 2:1 AV block. The patient remained asymptomatic.
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Pandit and Unzek Freiman Complete heart block associated with regadenoson
Journal of Nuclear Cardiology November/December 2012
Figure 3. The rhythm quickly then progressed to third-degree heart block for approximately 14 seconds with ventricular rate of 20 beats per minute.
Figure 4. Normal sinus rhythm with no AV blocks after reversal with aminophylline. Aminophylline 125 mg intravenous was given at the time of onset of second-degree heart block over approximately 45 seconds and heart block resolved within 30 seconds. Patient was observed for several hours and was discharged home without any further complications.
Conflict of interest
References
The authors have indicated that they have no financial conflicts of interest.
1. Iskandrian AE, Bateman TM, Belardinelli L, et al. Adenosine versus regadenoson comparative evaluation in myocardial perfusion
Journal of Nuclear Cardiology Volume 19, Number 6;1236–9
imaging: Results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol 2007;14:645-58. 2. Trochu JN, Zhao G, Post H, Xu X, Belardinelli L, Belloni FL, et al. Selective A2A ade
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