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Optimal dose of adenosine effective for supraventricular tachycardia in children.

AbstractOBJECTIVE:
To determine the optimal adenosine dose effective in supraventricular tachycardia (SVT) and underlying conditions affecting the effective dose in children.
STUDY DESIGN:
Experimental study.
PLACE AND DURATION OF STUDY:
Department of Cardiology, The Children's Hospital and Institute of Child Health, Lahore, from July 2008 to June 2011.
METHODOLOGY:
All children presenting with SVT were administered adenosine in rapid boluses according to PALS guidelines using incremental doses of 100, 200 and 300 μg/kg. The response was recorded on 12 lead ECG. Preexcitation was documented and echocardiography performed on all children after attaining sinus rhythm. Mann Whitney test and Kruskal-Wallis test were used as a test of significance to determine any difference in effective adenosine dose between normal heart and various underlying conditions, taking p < 0.05 as significant.
RESULTS:
Eighty five patients were treated for 110 episodes of SVT with adenosine. M:F ratio was 2.2:1. Their age ranged from 6 days to 14 years with mean age of 27.9 months. Adenosine was effective in reverting 97 episodes of SVT to sinus rhythm (88.2%). A dose of upto 100 μg/kg was only effective in 36.4% episodes of SVT. Two hundred μg/kg was effective in 44.3% of those not responding to 100 μg/kg dose (n = 31/70, cumulative 64.5%). A dose of 300 μg/kg was effective in further 25 patients not responding to lower doses (n = 25/38, 65.8%; cumulative 88.2%). Mean effective dose of adenosine was 185.3 + 81.0 μg/kg with median effective dose of 200 μg/kg. Significantly higher dose of adenosine was required in children with underlying pre-excitation, n = 18/97 (220.8 + 67.6 μg/kg vs. 177.2 + 81.9 μg/kg, p = 0.039).
CONCLUSION:
Adenosine is an effective medicine in treating SVT in children. A higher dose of 200 μg/kg may be used as first bolus particularly in children with pre-excitation.
AuthorsAhmad Usaid Qureshi, Syed Najam Hyder, Abdul Malik Sheikh, Masood Sadiq
JournalJournal of the College of Physicians and Surgeons--Pakistan : JCPSP (J Coll Physicians Surg Pak) Vol. 22 Issue 10 Pg. 648-51 (Oct 2012) ISSN: 1681-7168 [Electronic] Pakistan
PMID23058149 (Publication Type: Clinical Trial, Journal Article)
Chemical References
  • Anti-Arrhythmia Agents
  • Adenosine
Topics
  • Adenosine (administration & dosage, therapeutic use)
  • Adolescent
  • Anti-Arrhythmia Agents (administration & dosage, therapeutic use)
  • Child
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Echocardiography
  • Electrocardiography
  • Female
  • Guideline Adherence
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Pakistan
  • Practice Guidelines as Topic
  • Statistics, Nonparametric
  • Tachycardia, Supraventricular (drug therapy)
  • Treatment Outcome

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