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o d in th S g p in h n Adenosine is a naturally occurring nucleoside found roughout the human body. It has both antiarrhythmic nd vasodilatory properties, making it a useful diagnostic nd therapeutic agent in clinical cardiology. Adenosine as been used in the United States since 1989 for the anagement of reentrant supraventricular tachycardia VT) and is considered to be the initial drug of choice r the acute treatment of this frequently encountered rrhythmia. It is also commonly used off label to ifferentiate wide-complex tachycardias and is widely sed as a pharmacologic stress agent in conjunction with yocardial perfusion imaging (MPI). Adenosine has been reported to have an excellent fety profile, and serious adverse effects have been frequently reported. The most commonly encountered dverse effects are flushing, chest pain, and shortness of reath. Far less common, more serious adverse effects clude atrioventricular block, bronchospasm, bradycaria, and hemodynamically significant hypotension. ecause of adenosine’s short half-life, these effects are sually rapidly reversed with the termination of its dministration. Though not generally recognized, atrial fibrillation a potentially serious adverse effect of adenosine that as been reported, particularly when used to treat VT. Silverman et al reported reproducible adenosineduced atrial fibrillation in 5 patients undergoing elecophysiology testing for SVT. Garratt et al reported a ngle case of nonsustained atrial fibrillation in a patient sinus rhythm who received adenosine. Cases of susined atrial fibrillation after adenosine administration ave also been reported by McIntosh-Yellin et al and riffith et al. Atrial fibrillation occurring during adenosine pharacologic stress testing has been far less frequently ported. In fact, atrial fibrillation is not listed as a side