Adenosine for wide-complex tachycardia: efficacy and safety
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Keith A Marill1, Sigrid Wolfram, Ian S Desouza
1Department of Emergency Medicine (KAM), Massachusetts General Hospital, Boston, MA, USA. kmarill@partners.org
Objectives:
: To determine whether adenosine is useful and safe as a diagnostic and therapeutic agent for patients with undifferentiated wide QRS complex tachycardia. The etiology of sustained monomorphic wide QRS complex tachycardia is often uncertain acutely.
Design:
: A retrospective observational study.
Setting:
: Treatment associated with emergency visits at nine urban hospitals.
Patients:
: Consecutive patients treated with adenosine for regular wide QRS complex tachycardia between 1991 and 2006.
Interventions:
: Treatment with adenosine infusion.
Measurements And Main Results:
: Measured outcomes included rhythm response to adenosine, if any, and all adverse effects. A positive response was defined as an observed change in rhythm including temporary atrioventricular conduction block or tachycardia termination. A primary adverse event was defined as emergent electrical or medical therapy instituted in response to an adverse adenosine effect. A rhythm diagnosis was made in each case. The characteristics of adenosine administration as a test for a supraventricular as opposed to ventricular tachycardia were determined, and the adverse event rates were calculated. A total of 197 patients were included: 104 (90%) of 116 (95% confidence interval, 83%-95%) and two (2%) of 81 (95% confidence interval, 0.3%-9%) supraventricular tachycardia and ventricular tachycardia patients demonstrated a response to adenosine, respectively. The odds of supraventricular tachycardia increased by a factor of 36 (95% confidence interval, 9-143) after a positive response to adenosine. The odds of ventricular tachycardia increased by a factor of 9 (95% confidence interval, 6-16) when there was no response to adenosine. The rate of primary adverse events for patients with supraventricular tachycardia and ventricular tachycardia was 0 (0%) of 116 (95% confidence interval, 0%-3%) and 0 (0%) of 81 (95% confidence interval, 0%-4%), respectively.
Conclusions:
: Adenosine is useful and safe as a diagnostic and therapeutic agent for patients with regular wide QRS complex tachycardia.
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