Authors: Nichole Krug, Paige Baize, Stephanie Barre, Robert Barnes, Katherine Weigartz
Journal: American Journal of Emergency Medicine, September 2024
Conclusion: A 12 mg initial adenosine dose was associated with a higher rate of SVT termination in the ED compared to the guideline-recommended 6 mg dose. No significant differences were observed in adverse effects between the two dosing strategies. This suggests that an initial 12 mg dose may be more effective for terminating SVT in the ED setting.
Methods: This was a multi-center, retrospective cohort study conducted between January 1, 2020, and June 30, 2022. Patients who presented to the ED with SVT and received adenosine were included. The primary outcome was the rate of SVT termination as documented on an electrocardiogram after an initial 6 mg or 12 mg adenosine dose. Secondary outcomes included SVT termination with subsequent adenosine doses, time to ED disposition, adverse effects, and subgroup analyses of patients with a body mass index (BMI) ≥40 kg/m² and a history of SVT.
Results:
- A total of 213 patients were included, with 117 (54.9%) receiving an initial 6 mg dose and 96 (45.1%) receiving an initial 12 mg dose.
- SVT termination rates following the initial dose were significantly higher with 12 mg (79.1%) compared to 6 mg (56.4%) (p < 0.001).
- Among those who did not convert to sinus rhythm with the initial 6 mg dose, 71.7% (33/46) converted after a subsequent dose, while only 14.3% (1/7) converted after a subsequent dose in the 12 mg group (p = 0.007).
- The median time to ED disposition was not significantly different between the two groups (209 minutes for 6 mg vs. 161 minutes for 12 mg, p = 0.104).
- No significant differences were found in adverse effects or in the subgroup analyses of patients with BMI ≥40 kg/m² or a history of SVT.