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Usefulness of adenosine for arrhythmias in infants and children
E D Overholt1, K S Rheuban, H P Gutgesell
1Department of Pediatrics and Medicine, University of Virginia School of Medicine, Charlottesville.
Insights
Adenosine effectively treated arrhythmias in 25 children by terminating tachycardia or causing transient atrioventricular block. This study confirms adenosine
Area of Science:
- Pediatric Cardiology
- Clinical Electrophysiology
- Pharmacology
Background:
- Arrhythmias in infants and children require safe and effective treatment options.
- Adenosine's electrophysiologic effects in pediatric populations are not fully elucidated.
- Diagnostic electrophysiologic studies are crucial for managing pediatric arrhythmias.
Purpose of the Study:
- To evaluate the electrophysiologic effects of adenosine in pediatric patients.
- To determine the efficacy and safety of adenosine for arrhythmia termination.
- To assess adenosine's role in diagnostic electrophysiologic studies.
Main Methods:
- Adenosine administered as intravenous bolus to 25 infants and children.
- Dose titration (starting at 37.5 mcg/kg, increasing by 37.5 mcg/kg increments).
- Evaluation of effects on tachycardia and atrioventricular (AV) conduction.
Main Results:
- Adenosine terminated tachycardia or induced transient AV block in all 25 patients.
- Effective doses varied by arrhythmia type (e.g., 131 mcg/kg for atrial tachycardia, 114 mcg/kg for AVNRT).
- Minor side effects occurred in 24% of patients; one required temporary pacing for bradycardia.
Conclusions:
- Adenosine is a safe and effective agent for evaluating and treating pediatric arrhythmias.
- Intravenous adenosine demonstrates significant efficacy in terminating various supraventricular tachycardias in children.
- Further research can explore optimal dosing strategies for specific pediatric arrhythmia subtypes.
Abstract:
Adenosine was administered to 25 infants and children (11 patients after presenting with a sustained arrhythmia, and 14 during a diagnostic electrophysiologic study) to determine its electrophysiologic effects. Adenosine was given as an intravenous bolus (starting dose 37.5 micrograms/kg, and increased by 37.5 micrograms/kg increments until an effect was seen). Adenosine caused tachycardia termination or transient increased atrioventricular (AV) block in all 25 patients. Seven patients had tachycardia requiring only the atria for perpetuation and developed increased AV nodal block (minimum effective adenosine dose range 37.5 to 350 micrograms/kg, mean 131). Thirteen had AV reciprocating tachycardia or AV node reentry tachycardia (minimum effective adenosine dose range 37.5 to 225 micrograms/kg, mean 114). Four other patients received adenosine to rule out preexcitation (minimum effective adenosine dose range 37.5 to 375 micrograms/kg, mean 165). One of the 25 patients had junctional ectopic tachycardia and adenosine administration caused retrograde AV block. Six of the 25 (24%) had noticeable but minor side effects. One patient had sustained bradycardia (2 to 3 minutes requiring temporary pacing). Adenosine is a safe and effective agent in the evaluation and treatment of infants and children with arrhythmias.