Adenosine Safe for Pediatric Tachyarrhythmia

TOPLINE: 

Adenosine is safe for treating supraventricular tachycardia (SVT) in children in emergency settings, and patients have not experienced sustained ventricular tachycardia or prolonged cardiac pauses requiring intervention.

METHODOLOGY:

• Researchers conducted a retrospective, cross-sectional, multi-hospital study involving 77 patients younger than 18 years (34 girls; median age, 9 years) treated with adenosine for tachyarrhythmia in the emergency department between 2002 and 2022.
• They collected demographic information and data on past medical history, vital signs, treatments, and outcomes from electronic records, and reviewed electrocardiograms before, during, and after adenosine administration.
• Patients weighing over 60 kg received an initial dose of 6 mg or 12 mg of adenosine, whereas those under 60 kg received a weight-based dose ranging from 0.07 to 0.38 mg/kg.
• Researchers primarily assessed the incidence of serious side effects requiring intervention, and the secondary outcomes included the number of patients who needed additional treatments or electrical cardioversion.

TAKEAWAY:

• Adenosine treatment in pediatric patients with typical SVT was safe. While 17 patients had at least three consecutive ventricular beats following adenosine administration; none of them required intervention.
• Four patients required electrical cardioversion for persistent dysrhythmias, including two for SVT with hypotension, one for atrial fibrillation, and one for an undetermined rhythm.
• No significant risk factors, including age, sex, prior history of SVT, initial dose of adenosine, and the need for additional doses, were identified for prolonged sinus pause or more than two ventricular beats.
• One patient experienced brief hypotension after adenosine administration, which normalized without intervention.

IN PRACTICE:

“The use of adenosine is safe in the vast number of children with typical SVT that is narrow, regular and uniform. More caution is advised if patients have hypotension, signs of heart-failure, long QT syndrome, or other less common atrial rhythms,” the authors wrote.

SOURCE:

The study was led by Melanie M. Randall, Loma Linda University Children’s Hospital, Loma Linda, California. It was published online on August 30, 2024, in the International Journal of Emergency Medicine.

LIMITATIONS: 

The study was limited by its retrospective design.

DISCLOSURES:

The study did not receive any funding. The authors declared that they had no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.