Adenosine for the Prehospital Treatment of Paroxysmal Supraventricular Tachycardia

Gausche, Marianne; Persse, David; Sugarman, Thomas; Shea, Stephen R; Palmer, Gregory L; Lewis, Roger J.; Brueske, Patricia J; Mahadevan, Swaminatha V.; Melio, Frantz R.; Kuwata, John H.; Niemann, James T.

doi:10.1016/s0196-0644(94)70128-8

Cited by 58 publications

(43 citation statements)

References 22 publications

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“…A number of studies [381][382][383][384][385][386][387][388][389][390][391][392][393][394][395][396][397][398] support the use of adenosine in the treatment of stable PSVT. Although 2 randomized clinical trials 383,386 documented a similar PSVT conversion rate between adenosine and calcium channel blockers, adenosine was more rapid and had fewer severe side effects than verapamil.…”

Section: Therapymentioning

confidence: 99%

Part 8: Adult Advanced Cardiovascular Life Support

Neumar¹,

Otto²,

Link³

et al. 2010

Circulation

1,338

872

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Section: Therapymentioning

confidence: 99%

Part 8: Adult Advanced Cardiovascular Life Support

Neumar¹,

Otto²,

Link³

et al. 2010

Circulation

1,338

872

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“…A second tecadenoson bolus recruited more conversions in all regimens except in E, perhaps representing a saturation of the AV nodal receptors (14) 2 (14) 4 (14) 5 (22) 5 (22) 18 (18) Ventricular ectopy 1 (17) 2 (14) 1 (7) 3 (11) 5 (22) 5 (22) 16 (16) Second-degree AV block 0 0 0 2 (7) 4 (17) 6 (26) 12 ( after the first tecadenoson dose in regimen E. The rate of conversion of PSVT in tecadenoson regimen C is close to what has been reported with adenosine (85% to 96%). [11][12][13] The median time to tecadenoson-related conversion was also dose dependent. Conversion occurred in Ͻ1 minute with the 3 highest dose regimens (300/600, 450/900, and 900 g/900 g) but was Ͼ2 minutes for the 2 lower dose regimens (75/150 and 150 g/300 g.…”

Section: Discussionmentioning

confidence: 93%

Trial to Evaluate the Management of Paroxysmal Supraventricular Tachycardia During an Electrophysiology Study With Tecadenoson

et al. 2005

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Background-Tecadenoson is a potent selective A 1 -adenosine receptor agonist with a dose-dependent negative dromotropic effect on the AV node. Tecadenoson terminates induced paroxysmal supraventricular tachycardia (PSVT) without the clinically significant side effects caused by stimulation of other adenosine receptors. This trial was designed to determine a safe and effective tecadenoson bolus for termination of electrophysiologically induced PSVT. Methods and Results-Patients with a history of symptomatic PSVT and inducible PSVT at the time of a clinically indicated electrophysiology study were randomized into a multicenter, double-blind, placebo-controlled trial. Five 2-dose tecadenoson bolus regimens were evaluated versus placebo (75/150, 150/300, 300/600, 450/900, 900 g/900 g). The second bolus was administered only if PSVT persisted for 1 minute after the first bolus. Each tecadenoson regimen resulted in a significant therapeutic conversion rate compared with placebo (range, 50.0% to 90.3%, analysis of all patients dosed; nϭ181; PϽ0.0005). Conversion by the first bolus was dose related (range: placebo, 3.3% to 86.7% for 900 g/900 g). Time to conversion was dose dependent, with a median time of Ͻ1 minute for the 3 highest dose regimens. Postconversion arrhythmias were transient, requiring no additional treatment in 4 regimens (including placebo). Transient second-and third-degree heart block occurred at higher doses (300/600, 450/900, 900 g/900 g) and was supported with backup pacing when needed. No effect on blood pressure was observed. Ten patients with a history of asthma or chronic obstructive pulmonary disease tolerated tecadenoson without bronchospasm. Conclusions-We identified an optimal tecadenoson regimen (300 g/600 g) that effectively and rapidly converted 90% (28 of 31) of PSVT patients to normal sinus rhythm with no significant adverse effects. (Circulation. 2005;111:3202-3208.)

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“…3 This study did not consider the effects of rotating shifts. Most of the subjects were presumably permanent day workers and most exposures occurred in the middle of the day.…”

Section: Harold Thomas MDmentioning

confidence: 99%

To Treat or Not to Treat (Out‐of‐hospital) Paroxysmal Supraventricular Tachycardia, That Is the Question

Gausche

1996

Academic Emergency Medicine

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REFERENCESGausche et al. also evaluated the efficacy and feasibility of the use of adenosine for the treatment of PSVT in the out-of-hospital setting. These investigators defined PSVT as a narrow-complex tachycardia with a rate of 2140 beatdmin. Adenosine was administered in a 12-mg followed by 12-mg dosing regimen. Eighty-five of 107 tachycardic patients (79%) were subsequently found to be in PSVT, and 85% of these patients converted to sinus rhythm with adenosine. The recurrence rate was 1.6% and the complication rate was 11%. The authors also noted that 60 of 85 (71%) of the patients in PSVT were unstable (chest pain, hypotension, rales) and that adenosine treatment resulted in improved hemodynamic status. ' Furlong et al. and Lozano et al. confirmed the efficacy and safety of adenosine use for PSVT in EMS systems in which adenosine was administered without direct medical c~ntrol.~" Similar to the current study's design, Madsen et al. reported the use of adenosine prospectively and the use of verapamil retrospectively over a 12-month period in San Francisco.Treating Out-of-hospital PSVT, Gausche 565Of 102 patients in presumed PSVT, only 17 (17%) were treated with verapamil, whereas 64 of 89 (72%) patients believed by paramedics to be in PSVT were treated with adenosine.7 Conversion rates were similar for the 2 drugs (82% for verapamil vs 78% for adenosine), although the sample size for the verapamil group was small. Complication rates were higher in the adenosine group (45% vs 29%) but were more transient than the complications in the verapamil group. One patient receiving verapamil remained hypotensive for 16 minutes. Misdiagnosis of the initial cardiac rhythm by paramedics was as high as 41% during the adenosine study period. These authors concluded that base-station physicians were significantly more likely to order adenosine than erap pa mil.^ Although Shaw et al., in an outof-hospital study of verapamil use reported a successful conversion rate of only 50% for 24 patients in PSVT, other in-hospital investigators have shown comparable conversion rates of 93% with adenosine and 91% with verapamil.6.8 The out-of-hospital study of Shaw et al. had no major complication with the use of verapamil.In the current study with direct medical control over drug use, Brady et al. reported that the conversion rates for adenosine (69%) and verapamil (83%) were not significantly different.' Again, adenosine was significantly more likely to be ordered by base-station personnel for the treatment of PSVT (83%) than was verapamil (49%); p < 0.001. Basestation personnel may have applied stricter criteria before approving drug use during the verapamil intervention period, thus creating a biased (elevated) conversion rate in the verapamil group. This finding also highlights the problem with patient selection bias that may occur with retrospective studies. The conversion rate for adenosine was much lower in the study by Brady et al. (69% vs 85%) than it was for other EMS studies.'.' It is not clear why the conversion rate was l...

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Adenosine for the Prehospital Treatment of Paroxysmal Supraventricular Tachycardia

Cited by 58 publications

References 22 publications

Part 8: Adult Advanced Cardiovascular Life Support

Part 8: Adult Advanced Cardiovascular Life Support

Trial to Evaluate the Management of Paroxysmal Supraventricular Tachycardia During an Electrophysiology Study With Tecadenoson

To Treat or Not to Treat (Out‐of‐hospital) Paroxysmal Supraventricular Tachycardia, That Is the Question

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