Use of adenosine in the treatment of supraventricular tachycardia in a pediatric emergency department.
OBJECTIVE
Supraventricular tachycardia (SVT) is the most frequent arrhythmia requiring treatment in childhood, with an estimated incidence of 1/100 to 1/250 children. The treatment of choice of the acute event is intravenous adenosine. This study aimed to determine if doses of adenosine higher than previously described are needed to successfully revert SVT in children.


METHODS
This is a retrospective study of SVT cases in a tertiary hospital from January 2007 to December 2011.


RESULTS
A total of 44 episodes of SVT were recorded in 26 patients. Mean age was 3.1 years. In 39 patients (89%), adenosine was administered, reverting to stable sinus rhythm in 29 episodes, which represents an effectiveness of 75%. In relation to the number of doses administered, 12 patients (30%) received a single dose, with a mean (SD) response dose of 112 (35) µg/kg; 16 (41%) received 2 doses, with a mean (SD) response dose of 188 (55) µg/kg; and 9 (24%) received 3 doses, with a mean (SD) response dose of 249 (108) µg/kg. Finally, in 2 patients (4%), 4 doses of adenosine were administered, with only 1 of them responding to a dose of 300 µg/kg. The mean (SD) dose that reverted the SVT to normal sinus rhythm was 173 (84) µg/kg, and the mean (SD) number of doses administered was 1.7 (0.8) (range, 1-4). Sixty-six percent were discharged home, without the need to be transferred to pediatric intensive care unit or pediatric ward.


CONCLUSIONS
Most of the patients with SVT episodes require treatment with more than 1 dose of adenosine. Doses higher than the usually described in the guidelines are necessary to revert SVT. Most patients can be discharged home from the emergency department, without the need of hospital admission.
From the *Department for Critical Care and Emergencies, and †Pediatric Cardiology Unit, Heart and Cardiovascular Diseases Department, Department of Pediatrics, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
Sandra
S
Díaz-Parra
Pilar
P
Sánchez-Yañez
Ignacio
I
Zabala-Argüelles
Beatriz
B
Picazo-Angelin
Lourdes
L
Conejo-Muñoz
Victorio
V
Cuenca-Peiró
Isabel
I
Durán-Hidalgo
Patricia
P
García-Soler
D000241:Adenosine / Q000008:administration & dosage* / Q000627:therapeutic use; D000293:Adolescent; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000188:drug therapy*; D062606:Tertiary Care Centers; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000241:Adenosine