Efficacy and safety of adenosine in the treatment of supraventricular tachycardia in infants and children.

J Till, E A Shinebourne, M L Rigby, B Clarke, D E Ward, E Rowland

Department of Paediatric Cardiology, Brompton Hospital, London.

One hundred and seventeen episodes of supraventricular tachycardia in 50 children, including 28 infants, were treated with intravenous adenosine. Adenosine was prepared in a sterile solution of 0.9% saline (1 mg/ml) and given in incremental doses of 0.05 mg/kg every two minutes to a maximum of 0.25 mg/kg. Ninety of the 117 episodes were terminated. This included 88 of the 102 episodes of junctional tachycardia (79 of the 92 episodes of atrioventricular reentry tachycardia, seven of the eight episodes of atrioventricular nodal reentry tachycardia, and both of the episodes of long R-P' tachycardia). Only one of four episodes of His bundle tachycardia and one of the eight episodes of ectopic atrial tachycardia were terminated. None of the three episodes of atrial flutter were terminated. Side effects were frequent but mild and included transient complete atrioventricular block (less than 6 s), sinus bradycardia (less than 40 s), ventricular extrasystoles, flushing, nausea, headache, and respiratory disturbance. Reinitiation (within 5 s) of supraventricular tachycardia occurred in 13 of the terminated episodes. Although reinitiation limited its clinical efficacy in some patients, intravenous adenosine offered a safe and efficient method of rapid termination of most episodes of supraventricular tachycardia and in some cases facilitated diagnosis of the mechanism.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Verheij, G., Smits-Wintjens, V., Rozendaal, L., Blom, N., Walther, F., Lopriore, E. (2009). Cardiac arrhythmias associated with umbilical venous catheterisation in neonates. BMJ Case Reports 2009: bcr0420091778-bcr0420091778 [Abstract] [Full Text]  
• Fox, D. J., Tischenko, A., Krahn, A. D., Skanes, A. C., Gula, L. J., Yee, R. K., Klein, G. J. (2008). Supraventricular Tachycardia: Diagnosis and Management. Mayo Clin Proc. 83: 1400-1411 [Abstract] [Full Text]  
• Dixon, J, Foster, K, Wyllie, J, Wren, C (2005). Guidelines and adenosine dosing in supraventricular tachycardia. Arch. Dis. Child. 90: 1190-1191 [Abstract] [Full Text]  
• Mallet, M L (2004). Proarrhythmic effects of adenosine: a review of the literature. Emerg. Med. J. 21: 408-410 [Abstract] [Full Text]  
• Tan, H.L., Lie, K.I. (2001). Treatment of tachyarrhythmias during pregnancy and lactation. Eur Heart J 22: 458-464  
• Botero, M., Davies, L. K. (2001). Diagnosis and Management of Arrhythmias in Children After Cardiac Surgery. SEMIN CARDIOTHORAC VASC ANESTH 5: 122-133 [Abstract]  
• Hancox, J C, Patel, K C R, Jones, J V (2000). Antiarrhythmics---from cell to clinic: past, present, and future. Heart 84: 14-24 [Full Text]  
• Blahunka, P. C. (1996). Pediatric Advanced Life Support (PALS): The Pharmacist's Role. Journal of Pharmacy Practice 9: 42-56 [Abstract]  
• Getschman, S. J., Dietrich, A. M., Franklin, W. H., Allen, H. D. (1994). Intraosseous Adenosine: As Effective as Peripheral or Central Venous Administration?. Arch Pediatr Adolesc Med 148: 616-619 [Abstract]  
• Berul, C. I. (1993). Higher Adenosine Dosage Required for Supraventricular Tachycardia in Infants Treated with Theophylline. CLIN PEDIATR 32: 167-168  
• (1992). Pediatric Advanced Life Support. JAMA 268: 2262-2275 [Abstract]  
• Rankin, A. C., McGovern, B. A. (1991). Adenosine or Verapamil for the Acute Treatment of Supraventricular Tachycardia?. ANN INTERN MED 114: 513-515 [Abstract]  
• Minton, N. A., Henry, J. A. (1991). Pharmacodynamic Interactions Between Infused Adenosine and Oral Theophylline. Hum Exp Toxicol 10: 411-418 [Abstract]