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[Therapeutic efficacy and diagnostic potential of adenosine in infants and children]
J P Pfammatter1, T Paul, D Bachmann
1Abteilung für Pädiatrische Kardiologie, Universitätsklinik Bern.
Insights
Intravenous adenosine effectively treats supraventricular tachycardia in pediatric patients, with 87% of narrow-QRS-complex tachycardias converted to sinus rhythm. Adenosine also aids in diagnosing wide-QRS-complex tachycardias.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
Context:
- Supraventricular reentrant tachycardia (SVT) is a common arrhythmia in infants and children.
- Effective and safe treatment options are crucial for managing pediatric SVT.
Purpose:
- To evaluate the efficacy and safety of intravenous adenosine for treating supraventricular tachycardia in pediatric patients.
- To determine the optimal dosage and diagnostic utility of adenosine in pediatric arrhythmias.
Summary:
- A study involving 31 infants and children treated 53 episodes of SVT with intravenous adenosine.
- Adenosine, administered as a rapid bolus injection starting at 0.1 mg/kg and titrated up to 0.3 mg/kg, successfully terminated 87% of narrow-QRS-complex tachycardias.
- Adenosine also proved useful in diagnosing the origin of wide-QRS-complex tachycardias and identifying flutter waves.
Impact:
- Adenosine is a highly effective first-line therapy for pediatric supraventricular tachycardia.
- The drug is generally well-tolerated, with mild and transient side effects.
- Adenosine's diagnostic capabilities enhance its utility in pediatric electrophysiology.
Abstract:
In an open study a total of 53 episodes of supraventricular reentrant tachycardia in 31 infants and children were treated with intravenous adenosine at two centers. Adenosine was given as a rapid intravenous bolus injection beginning with a dose of 0.1 mg/kg. If there was persistence of the dysrhythmia dosage was increased in 0.05 mg/kg-steps up to a maximum dose of 0.3 mg/kg if necessary. The median dose required for successful termination of the tachycardias was 0.15 mg/kg. In 26 patients with 48 episodes of regular narrow-QRS-complex tachycardia adenosine was used as the therapeutic agent of first choice. In all patients a shortlasting atrioventricular block occurred within seconds after the administration of adenosine. In 42 of 48 episodes of tachycardia (87%) the dysrhythmias were converted to a stable sinus rhythm. In six episodes (13%) recurrence of the tachycardia was observed immediately. In five children adenosine was used for diagnostic purpose: in three children with wide-QRS-complex tachycardia successful termination with adenosine proved the supraventricular origin of the dysrhythmia. In two children with suspected atrial flutter adenosine-induced atrioventricular block allowed identification of flutter waves in one patient while in the other patient no effect of adenosine was seen. Side-effects such as flush, chest-pain or abdominal pain were frequent but mild and only of a few seconds' duration. No influence of adenosine on blood pressure was noted. Only in one child with previously unknown sinus node dysfunction was a relevant electrophysiologic side effect seen: a prolonged sinus arrest with asystole of 12 seconds' duration occurred after adenosine administration.(ABSTRACT TRUNCATED AT 250 WORDS)