Delayed adenosine therapy is associated with the refractory supraventricular tachycardia in children
Jung Heon Kim1, Jae Yun Jung2, Se Uk Lee3
1Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea(1); Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Insights
Prompt adenosine therapy is crucial for children with supraventricular tachycardia (SVT). Delayed treatment increases the risk of refractory SVT, highlighting the need for rapid intervention in pediatric emergency care.
Area of Science:
- Pediatric Cardiology
- Emergency Medicine
- Clinical Pharmacology
Background:
- Supraventricular tachycardia (SVT) is a common arrhythmia in children.
- Adenosine is a first-line pharmacologic agent for SVT conversion.
- Refractory SVT, persisting despite adenosine, requires further management.
Purpose of the Study:
- To investigate the association between time intervals in adenosine administration and refractory SVT in pediatric patients.
- To identify factors contributing to adenosine-refractory SVT in children.
Main Methods:
- Retrospective review of 334 SVT episodes in children (<18 years) across four academic EDs (July 2013-June 2017).
- Defined refractory SVT as persistence after two adenosine doses.
- Compared clinical, electrocardiographic, and time-to-adenosine intervals between refractory and responsive SVT episodes.
- Utilized multivariable logistic regression to determine factors associated with refractory SVT.
Main Results:
- Out of 211 SVT episodes, 42 (19.9%) were refractory to adenosine.
- Refractory SVT episodes showed a higher prevalence of structural heart disease (9.5% vs. 1.8%, P=0.030).
- A longer median ED-to-adenosine time was significantly associated with refractory SVT (15.5 vs. 11.0 min, P=0.018).
- Each minute increase in ED-to-adenosine time correlated with a 2% increased odds of refractory SVT (aOR, 1.02; 95% CI, 1.007-1.04).
Conclusions:
- Delayed adenosine administration is linked to the occurrence of refractory SVT in pediatric patients.
- Prompt initiation of adenosine therapy is essential for effective SVT management in children.
- Timely intervention in the emergency department can improve SVT conversion rates.
Objectives:
To study the association of time intervals on adenosine therapy with the occurrence of refractory supraventricular tachycardia (SVT) in children.
Methods:
We reviewed 334 episodes of presumed SVT requiring adenosine in children (<18 years) who visited 4 academic hospital emergency departments (EDs) from July 2013 through June 2017. Refractory SVT was defined as an SVT episode persisting after 2 doses of adenosine. Clinical and electrocardiographic findings, and symptom-to-adenosine (symptom-to-ED plus ED-to-adenosine) time of refractory and responsive SVT episodes were compared. Multivariable logistic regression was performed to identify factors associated with the occurrence of refractory SVT.
Results:
Of 211 SVT episodes, 42 episodes of refractory SVT (19.9%) were noted (overall sinus conversion rate, 79.6%). The refractory episodes were associated with a higher frequency of known structural heart diseases (9.5% vs. 1.8%; P = 0.030) and a longer median ED-to-adenosine time (15.5 vs. 11.0 min; P = 0.018). The association of the ED-to-adenosine time with refractory SVT remained significant after adjustment (for increment of 1 min; aOR, 1.02; 95% CI, 1.007-1.04).
Conclusions:
Delayed adenosine therapy is associated with the occurrence of refractory SVT in children, supporting the need for prompt adenosine therapy.
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