Key result
In an 8-year-old girl with supraventricular tachycardia, a 200 µg/kg dose of adenosine successfully restored sinus rhythm after an initial 100 µg/kg dose failed, prompting a literature review.
Why the study?
In children with supraventricular tachycardia, does high dose adenosine compared with low dose adenosine achieve higher rates of cardioversion?
Case Report (n=1)
In children with supraventricular tachycardia, does high dose adenosine compared with low dose adenosine achieve higher rates of cardioversion?
This clinical question formulation seeks to determine if a higher initial dose of adenosine is more effective than a lower dose for cardioverting supraventricular tachycardia in children.
Higher-dose adenosine may terminate refractory pediatric SVT; leaves open optimal dosing, safety, and need for prospective trials.
An 8-year-old girl attends the accident and emergency department complaining of palpitations and breathlessness for 1 h. An ECG confirms a diagnosis of supraventricular tachycardia (SVT). The patient is haemodynamically stable and vagal manoeuvres are ineffective. Intravenous access is obtained and a 100 µg/kg dose of adenosine is administered with persistence of SVT. A further higher dose of 200 µg/kg is administered with successful restoration of sinus rhythm. The case is discussed with colleagues, who indicate similar initial failures with lower doses of adenosine. You wonder if choosing the higher dose initially would be more effective at re-establishing sinus rhythm? In children with supraventricular tachycardia [patient], does high dose adenosine [intervention] compared with low dose adenosine [control] achieve higher rates of cardioversion [outcome]? ### Secondary sources A search of The Cochrane Library of systematic reviews and the BestBETS website identified no articles. ### Primary sources An Ovid Medline (1948–week 1 May 2011) search was performed using the search terms: Tachycardia, Supraventricular/ or Tachycardia, Atrioventricular Nodal Reentry/ or tachycardia, …
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Quail et al. (2012) conducted a case report in Supraventricular tachycardia (n=1). High dose adenosine vs. Low dose adenosine (100 µg/kg) was evaluated on Rates of cardioversion. In an 8-year-old girl with supraventricular tachycardia, a 200 µg/kg dose of adenosine successfully restored sinus rhythm after an initial 100 µg/kg dose failed, prompting a literature review.
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