title: Dexmedetomidine: therapeutic use for the termination of reentrant supraventricular tachycardia.
abstract: OBJECTIVE
  The current drug of choice for reentrant supraventricular tachycardia (SVT) is adenosine followed by verapamil or diltiazem. Although limitations and significant adverse events have been encountered over the years, an alternative effective and safe agent has not been available. Dexmedetomidine has recently been shown to have potential antiarrhythmic effects, and here we describe our experience in the acute termination of reentrant SVT.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Quaternary University Children's Hospital, Cardiac Intensive Care Unit.
  
  
  METHODS
  Patients who received dexmedetomidine for SVT in the past 5 years.
  
  
  METHODS
  None.
  
  
  METHODS
  SVT episodes terminated with dexmedetomidine were compared with episodes terminated with adenosine.
  
  
  RESULTS
  Fifteen patients, median age of 10 days (6-16), were given 27 doses of dexmedetomidine, mean dose 0.7 ± 0.3 mcg/kg, for a total of 27 episodes of SVT. Successful termination occurred in 26 episodes (96%) at a median time of 30 seconds (20-35). Duration of sinus pause was 0.6 ± 0.2 seconds, there was one episode of hypotension and no bradycardia and sedation lasted for 34 ± 8 minutes. Five patients received 27 doses of adenosine, with an overall successful cardioversion in 17 patients (63%) (P= .0017). Transient bradycardia and hypotension was seen in three patients (11%), agitation in 16 patients (59%), and broncospasm in one patient. Median sinus pause was 2.5 seconds (2-9) (P < .001).
  
  
  CONCLUSIONS
  Dexmedetomidine appears to have novel antiarrhythmic properties for the acute termination of reentrant SVT. Although adenosine is very effective, dexmedetomidine may prove to possess a more favorable therapeutic profile with increased effectiveness and fewer side effects.
authors.affiliation: Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA. chrycx@chp.edu
authors.forename: Constantinos
authors.initials: C
authors.lastname: Chrysostomou
authors.forename: Victor O
authors.initials: VO
authors.lastname: Morell
authors.forename: Peter
authors.initials: P
authors.lastname: Wearden
authors.forename: Joan
authors.initials: J
authors.lastname: Sanchez-de-Toledo
authors.forename: Edmund H
authors.initials: EH
authors.lastname: Jooste
authors.forename: Lee
authors.initials: L
authors.lastname: Beerman
mesh_terms: D000241:Adenosine / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000494:pharmacology* / Q000627:therapeutic use*; D006330:Heart Defects, Congenital / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000889:Anti-Arrhythmia Agents; D020927:Dexmedetomidine; D000241:Adenosine