Key result
Initial 12 mg adenosine linked to ~60% higher first-dose SVT conversion vs 6 mg.
Why the study?
The study aimed to compare the efficacy and safety of an initial 12 mg versus 6 mg adenosine dose for sinus rhythm conversion in ED patients presenting with SVT.
Does an initial 12 mg adenosine dose improve successful first-dose sinus rhythm conversion in adult patients presenting to the ED with hemodynamically stable SVT compared to a 6 mg dose?
Observational (n=142)
Does an initial 12 mg adenosine dose improve successful first-dose sinus rhythm conversion in adult patients presenting to the ED with hemodynamically stable SVT compared to a 6 mg dose?
Effect estimate: OR 4.12 (95% CI 1.85-9.14)
Absolute Event Rate: 83.1% vs 52.1%
An initial 12 mg dose of adenosine is more effective than a 6 mg dose for first-dose sinus rhythm conversion in hemodynamically stable SVT, without increasing adverse effects.
May support 12-mg initial adenosine for stable SVT in ED; leaves open adoption pending RCTs before practice change.
OBJECTIVES: This study aimed to compare the efficacy and safety of an initial 12 mg versus 6 mg adenosine dose for sinus rhythm conversion in patients presenting with supraventricular tachycardia (SVT) in the emergency department (ED). METHODS: This prospective observational study was conducted between February 2025 and January 2026. Adult patients (≥ 18 years) presenting to the ED with hemodynamically stable SVT confirmed by 12-lead electrocardiography (ECG) were included. Patients were categorized into two groups according to the initial adenosine dose administered (6 mg vs. 12 mg). To address potential selection bias, 1:1 propensity score matching (PSM) was performed. The primary outcome was successful first-dose sinus rhythm conversion. Secondary outcomes included adenosine-related adverse effects and SVT recurrence during the ED stay. RESULTS: A total of 142 patients were analyzed (n = 71 per group). First-dose conversion was significantly higher with 12 mg compared with 6 mg (83.1% vs. 52.1%). In the PSM cohort (n = 104), the 12 mg dose maintained its superior efficacy (82.7% vs. 53.8%). The PSM-adjusted odds ratio for successful conversion was 4.12 (95% confidence interval [CI]: 1.85-9.14), with a number needed to treat (NNT) of 3.8 (95% CI: 2.5-8.3). SVT recurrence was numerically lower in the 12 mg group (1.4% vs. 9.9%). Adverse effects were similar between groups. CONCLUSIONS: An initial 12 mg adenosine dose was associated with higher first-dose sinus rhythm conversion than 6 mg, while adverse effects were similar between groups.
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Sert et al. (2026) conducted an observational in supraventricular tachycardia (SVT) (n=142). adenosine vs. 6 mg adenosine was evaluated on successful first-dose sinus rhythm conversion (OR 4.12, 95% CI 1.85-9.14). An initial 12 mg adenosine dose for supraventricular tachycardia yielded higher first-dose sinus rhythm conversion than 6 mg (83.1% vs. 52.1%; OR 4.12, 95% CI 1.85-9.14).
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