What is the next step if adenosine administration does not resolve atrial tachycardia?

When adenosine administration does not resolve atrial tachycardia, starting cardioversion is the appropriate next step. Adenosine is used as a first-line treatment due to its ability to transiently block the conduction through the atrioventricular (AV) node, which can interrupt reentrant tachycardias involving the AV node. However, if adenosine fails to terminate the atrial tachycardia, it indicates that the underlying mechanism may not be responsive to this medication or that the arrhythmia is more sustained and requires a different approach.

Cardioversion, which can be performed either synchronously (electrical cardioversion) or through pharmacological means, is utilized to reset the heart's rhythm and manage the ongoing tachycardia effectively. This method is especially critical in cases where the patient is hemodynamically unstable or experiencing significant symptoms due to the rapid heart rate.

In contrast, simply repeating the adenosine dose may not yield a different outcome since the arrest of tachycardia depends on the specific arrhythmia type and the patient’s overall stability. Increasing fluid intake or observing and waiting would not directly address the immediate need to restore a normal heart rhythm and could even exacerbate any underlying