Holdgate Anna, Foo Angeline
Emergency Medicine Research Unit, Liverpool Hospital, Liverpool, Australia. 2Department of Emergency Medicine, St GeorgeHospital, Kogarah, Australia.
Cochrane Database Syst Rev. 2012 Feb 15(2):CD005154. doi: 10.1002/14651858.CD005154.pub3.
Patients with paroxysmal supraventricular tachycardia frequently present to the Emergency Department. Where vagal manoeuvres fail, the two most commonly used drugs are adenosine and calcium channel antagonists. Both are known to be effective but both have a significant side-effect profile.
To examine the relative effects of adenosine and calcium channel antagonists and, if possible, to determine which is most appropriate for the management of supraventricular tachycardia.
Studies were identified from The Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, Issue 2, 2010, MEDLINE (1966 to May Week 1 2010) and EMBASE (1980 to 2010 week 19). The searches were originally run in June 2006 and updated and re-run in May 2010. Bibliographies of identified studies were also examined. No language restrictions were applied.
Randomised trials comparing adenosine and a calcium channel antagonist in patients of any age with supraventricular tachycardia, where one of the defined outcomes was reported. Outcomes of interest were: reversion rate, mortality, time to reversion, rate of relapse, major and minor adverse events, length of hospital stay and patient satisfaction.
Two authors independently checked the results of searches to identify relevant studies. Dichotomous outcomes were reported as Peto Odds ratios and continuous outcomes as weighted mean differences.
A total of ten trials were identified (two new trials were identified through the updated search in May 2010), all of which used verapamil as the calcium antagonist. In the pooled analysis there was no significant difference in reversion rate between the two drugs. Time to reversion was slower for verapamil than adenosine in all studies that reported this outcome, but the data were not suitable for combining. Relapse rates were higher for adenosine compared with verapamil (OR 0.25, 95% CI 0.07 to 0.99. P=0.05). Minor adverse events such as nausea, chest tightness, shortness of breath and headache were reported much more frequently in patients treated with adenosine with 10.8 % of patients reporting at least one of these events, compared with 0.6% of those treated with verapamil (OR 0.15, 95% CI 0.09 to 0.26, P<0.001). Hypotension was reported exclusively in the verapamil treatment group (4/214), and occurred in none of the patients treated with adenosine (OR 10.8, 95% CI 1.46 to 80.22, P=0.02).
AUTHORS' CONCLUSIONS: Adenosine and verapamil are both effective treatments for supraventricular tachycardia in the majority of patients. There is a high incidence of minor but unpleasant side effects and a greater risk of relapse in patients treated with adenosine while some patients treated with verapamil may develop significant hypotension. Patients should be fully informed of these risks prior to treatment.
阵发性室上性心动过速患者常前往急诊科就诊。当迷走神经刺激无效时，两种最常用的药物是腺苷和钙通道拮抗剂。已知这两种药物均有效，但都有明显的副作用。
研究腺苷和钙通道拮抗剂的相对疗效，并在可能的情况下确定哪种药物最适合用于室上性心动过速的治疗。
从Cochrane对照试验中心注册库（CENTRAL，2010年第2期Cochrane图书馆）、MEDLINE（1966年至2010年5月第1周）和EMBASE（1980年至2010年第19周）中检索相关研究。检索最初于2006年6月进行，并于2010年5月更新和重新运行。还查阅了已识别研究的参考文献。未设语言限制。
比较腺苷和钙通道拮抗剂用于任何年龄室上性心动过速患者的随机试验，其中报告了一项规定的结局。感兴趣的结局包括：转复率、死亡率、转复时间、复发率、主要和次要不良事件、住院时间和患者满意度。
两位作者独立检查检索结果以识别相关研究。二分类结局以Peto比值比报告，连续结局以加权均数差值报告。
共识别出10项试验（通过2010年5月的更新检索识别出2项新试验），所有试验均使用维拉帕米作为钙拮抗剂。在汇总分析中，两种药物的转复率无显著差异。在所有报告此结局的研究中，维拉帕米的转复时间比腺苷慢，但数据不适合合并。与维拉帕米相比，腺苷治疗患者的复发率更高（比值比0.25，95%可信区间0.07至0.99，P = 0.05）。腺苷治疗的患者中，恶心、胸闷、气短和头痛等轻微不良事件的报告频率更高，10.8%的患者报告至少出现其中一种事件，而维拉帕米治疗的患者中这一比例为0.6%（比值比0.15，95%可信区间0.09至0.26，P < 0.001）。低血压仅在维拉帕米治疗组中报告（4/214），腺苷治疗的患者中无一例发生（比值比10.8，95%可信区间1.46至80.22，P = 0.02）。
腺苷和维拉帕米对大多数室上性心动过速患者均为有效治疗方法。腺苷治疗的患者轻微但令人不适的副作用发生率较高，复发风险更大，而一些接受维拉帕米治疗的患者可能会出现显著低血压。治疗前应充分告知患者这些风险。
