Adenosine and Pediatric Supraventricular Tachycardia in the Emergency Department: Multicenter Study and Review☆,☆☆
Section snippets
INTRODUCTION
Supraventricular tachycardia (SVT) occurs in 1 of 250 to 1 of 1,000 children, making it the most common arrhythmia in the pediatric population. Adenosine is an endogenous nucleoside that transiently blocks atrioventricular (AV) conduction in the heart.1, 2, 3, 4, 5 Almost 90% of SVT in children is based on a re-entrant mechanism.6 For these reasons, adenosine should be effective for the termination of most pediatric SVT episodes. Reports of the use of adenosine in children are limited to
MATERIALS AND METHODS
Through the Collaborative Research Committee, Emergency Medicine Section, American Academy of Pediatrics, 6 of 23 pediatric emergency medicine physician committee members offered to participate in this study. The study protocol was approved by the review board of each center at which patients were entered prospectively. Consent beyond the standard consent for treatment in the ED was waived because adenosine is the drug of choice for SVT.
Children from birth to 18 years of age who received
RESULTS
Six pediatric emergency medicine physicians from 7 urban pediatric EDs (annual census, 22,000 to 70,000 visits) participated. There were 82 patients and a total of 98 presumed SVT events. One patient had 5 events, 3 patients had 3 events each, and 6 patients had 2 events each. There were 52 prospective and 46 retrospective patient-events. The range of patient entry dates for each investigator is presented in Table 1.Investigator Patients Entered
DISCUSSION
The overall success rate for conversion of 98 presumed SVT events in 82 pediatric patients treated in the ED was 72%. This compares with a rate of 77% (90/117) reported by Till et al10 in 50 hospitalized pediatric patients (1 to 17 years of age). Till et al reported an 86% (88/102) success rate for AV node–dependent SVT, compared with 79% in our study. Two ED studies of adult patients showed overall success rates of 54% and 85% and AV node–dependent SVT success rates of 85% and 96%.16, 17 Five
Acknowledgements
We thank Alice Sather for her help in the preparation of this manuscript.
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Cited by (112)
Delayed adenosine therapy is associated with the refractory supraventricular tachycardia in children
2020, American Journal of Emergency MedicineCitation Excerpt :The overall sinus conversion rate with adenosine approximates the known rates ranging from 72% to 77% [2,3]. The sinus conversion rate with 1 dose and the mean total dose were slightly higher than the values of 35%–36% [3,9] and 100–200 μg/kg [5,9,10] previously reported, respectively. This discrepancy supports the need for a higher first dose of adenosine [5].
Management of Pediatric Chest Pain, Palpitations, Syncope, and Murmur Presenting to the Emergency Department
2018, Clinical Pediatric Emergency MedicineAdenosine Administration With a Stopcock Technique Delivers Lower-Than-Intended Drug Doses
2018, Annals of Emergency MedicineCitation Excerpt :A prospective study to determine the optimal adenosine dose effective in supraventricular tachycardia showed a mean effective dose of 185.3 μg/kg (SD 81.0 μg/kg) (median 200 μg/kg) in 110 episodes of supraventricular tachycardia.7 Similarly, in another investigation, an initial adenosine dose greater than 0.1 mg/kg showed improved efficacy compared with doses less than 0.1 mg/kg (38% versus 22%), and significantly more doses of adenosine were required for cardioversion when a low initial dose was used.5 Higher doses of adenosine, up to 0.3 mg/kg, appear to be generally safe.5,9,10
Cardiopulmonary resuscitation (CPR) in children with heart disease
2018, Critical Heart Disease in Infants and ChildrenAcute Management of Refractory and Unstable Pediatric Supraventricular Tachycardia
2017, Journal of Pediatrics
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Address for reprints: Joseph D Losek, MD, Children’s Hospitals and Clinics—St Paul, 345 North Smith Avenue, St Paul, MN 55102; 651-220-6914.
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