Why the study?
Although adenosine is widely recognized as the first-line pharmacologic treatment for supraventricular tachycardia in children, its adequate dosage has been questioned since the late 1980s, and current guidelines offer heterogeneous and confusing dosage recommendations.
Does a higher initial dose of intravenous adenosine (at least 200-300 mcg/kg) improve acute termination of supraventricular tachycardia compared to standard lower starting doses (50-100 mcg/kg) in infants and children?
Does a higher initial dose of intravenous adenosine (at least 200-300 mcg/kg) improve acute termination of supraventricular tachycardia compared to standard lower starting doses (50-100 mcg/kg) in infants and children?
This literature review challenges current pediatric guidelines by recommending a higher initial intravenous adenosine dose of at least 200-300 mcg/kg to rapidly and safely terminate supraventricular tachycardia in children, avoiding treatment delays caused by ineffective 50-100 mcg/kg starting doses.
Answers are grounded in this paper and cite their sources.
May support higher initial adenosine dosing for pediatric SVT; leaves open confirmation in randomized trials before practice change.
Figure1.Mechanism for reentrant paroxy smalsupraventriculartachycardia.(A) A premature atrial complex (PAC) occurs and is blocked in a fast pathway, but it can propagate down the slower pathway.(B) By the time the electrical signal reaches the end of the slow pathway, the fast pathway has repolarized, and retrograde conduction of the wave occurs.(C) The wave then returns down the slow pathway, setting up a closed circuit that is self-sustaining.Abstract: SVT can be defined as an abnormally rapid heart rhythm originating above the ventricles, often (but not always) with a narrow QRS complex on ECG.Re-entrant SVT is the most frequent mechanism of tachycardia in childhood (>90%).Adenosine is widely recognized as the first line of pharmacologic treatment for SVT.Since, the initial clinical trials in late 1980s, the adequate dosage of adenosine have been questioned and current guidelines offer confusing advice about adenosine dosage in children, with very heterogeneous dosage recommendations.In this review of the pediatric literature we show that in several studies the optimal dose of adenosine is higher than the 0.1 mg/kg recommendation.Because adenosine is a drug with few adverse effects owing to its very short half-life, it seems advisable to recommend a higher initial dose, at least 200-300 mcg/kg.
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A 2017 study conducted a review in Supraventricular tachycardia (SVT). Adenosine vs. Standard lower initial guideline-recommended doses (50-100 mcg/kg) was evaluated on Termination of SVT (reversion to sinus rhythm).
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