@article{fe844296dc0245398588235a82c50459,
title = "Impact of dipyridamole on adenosine dosing in pediatric and young adult patients after heart transplantation",
abstract = "Background: Relative contraindications to adenosine use have included heart transplant and dipyridamole. We previously demonstrated the safety and efficacy of adenosine-induced atrioventricular (AV) block in healthy young heart transplant recipients while suspending dipyridamole therapy (dual antiplatelet agent). This prospective follow-up study evaluated the safety and efficacy of adenosine use in the same cohort of heart transplant recipients while on dipyridamole. Methods: Adenosine was incrementally dosed until AV block occurred (maximum 200 mcg/kg up to 12 mg). The primary outcome was clinically significant asystole (≥12 seconds). Secondary outcomes included maximal adenosine dose, AV block duration, dysrhythmias, and clinical symptoms. Outcomes were compared to the parent study. Results: Thirty of 39 eligible patients (5-24 years) were tested. No patient (0%, CI 0%-8%) experienced clinically significant asystole. AV block occurred in 29/30 patients (97%, CI 86%-100%). The median dose causing AV block was 50mcg/kg (vs 100 mcg/kg off dipyridamole; P =.011). Seventeen patients (57%, CI 39%-72%) required less adenosine to achieve AV block on dipyridamole; six (20%) required more. AV block occurred at doses ≥25 mcg/kg in all patients. In pairwise comparison to prior testing off dipyridamole, no significant change occurred in AV block duration, frequency of cardiac ectopy, or incidence of reported symptoms. No atrial fibrillation/flutter occurred. Conclusions: AV block often occurs at twofold lower adenosine doses in healthy young heart transplant recipients taking oral dipyridamole, compared with previous testing of this cohort off dipyridamole. Results suggest that initial dosing of 25 mcg/kg (maximum 0.8 mg) with stepwise escalation poses low risk of prolonged asystole on dipyridamole.",
keywords = "arrhythmia, atrioventricular block, heart transplant, supraventricular tachycardia",
author = "Satzer, {Michael B.} and Flyer, {Jonathan N.} and Zuckerman, {Warren A.} and Leonardo Liberman and Richmond, {Marc E.} and Anderson, {Brett R.} and Addonizio, {Linda J.} and Silver, {Eric S.}",
note = "Funding Information: The research team would like to thank the Columbia University Division of Pediatric Cardiology, Catheterization Lab and Heart Transplant teams, and Codruta Chiuzan, PhD, of the Irving Institute. Drs. Flyer and Silver received modest external research grant funding from the nonprofit organizations Matthew's Hearts of Hope and Colin's Kids, Inc. Drs. Flyer and Silver received other modest non‐financial research support from St. Jude Medical and Sagent Pharmaceuticals, Inc. Dr Anderson receives salary support from the National Heart Lung and Blood Institute, National Institutes of Health, through Grant Number K23 HL133454. This publication was also supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1 TR000040. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Funding Information: The research team would like to thank the Columbia University Division of Pediatric Cardiology, Catheterization Lab and Heart Transplant teams, and Codruta Chiuzan, PhD, of the Irving Institute. Drs. Flyer and Silver received modest external research grant funding from the nonprofit organizations Matthew's Hearts of Hope and Colin's Kids, Inc. Drs. Flyer and Silver received other modest non-financial research support from St. Jude Medical and Sagent Pharmaceuticals, Inc. Dr Anderson receives salary support from the National Heart Lung and Blood Institute, National Institutes of Health, through Grant Number K23 HL133454. This publication was also supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1 TR000040. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Publisher Copyright: {\textcopyright} 2020 Wiley Periodicals, Inc.",
year = "2020",
month = may,
day = "1",
doi = "10.1111/petr.13689",
language = "English (US)",
volume = "24",
journal = "Pediatric Transplantation",
issn = "1397-3142",
publisher = "Wiley-Blackwell",
number = "3",
}