Safety of Adenosine for Pediatric Tachyarrhythmia Treatment in the Emergency Department: a Multi-Hospital 10-year Cross-Sectional Study

Abstract

Background Supraventricular tachycardia is the most common dysrhythmia in children. Initial vagal maneuvers are successful less than half of the time. Adenosine, a potent AV nodal blocker with short half-life, is recommended as first line pharmacotherapy. Minor side effects from adenosine are common, but report of serious side effects such as sustained ventricular tachycardia, torsades de pointes, syncope or hypotension are confined to small case series or studies greater than 20 years old. We aimed to specifically identify the incidence of serious side effects of adenosine in children in the emergency department. Methods Between 2002 and 2022, all children less than 18 years old who received adenosine for tachyarrhythmia treatment in one of two emergency departments were included. The electronic record was reviewed for demographic information, patient history, treatments given, and side effects or complications were observed. Electrocardiograms before, during and after adenosine administration were reviewed. Results 77 patients met inclusion criteria. There were 73 patients with an initial rhythm of typical SVT. The other four patients included one with SVT with aberrancy, one with a junctional rhythm, one with atrial fibrillation, and one with an undetermined narrow complex tachycardia. 50 patients had cardiac rhythm monitoring during adenosine administration. 17 of these patients had three or more consecutive ventricular beats following adenosine, however no patients required treatment. No patients had syncope. One patient had brief hypotension after adenosine that normalized without intervention. Four patients were electrically cardioverted due to persistent SVT. Twelve patients were placed on continuous antiarrhythmic medication for persistent SVT. The patient with atrial fibrillation remained in atrial fibrillation despite adenosine and electrical cardioversion three times. The patient with undetermined tachycardia had no response to adenosine or amiodarone, then had brief cardiac arrest after intubation. Echocardiography showed heart failure. Conclusions Adenosine treatment in typical supraventricular tachycardia in pediatric patients is safe.