Safety and efficacy of central intravenous bolus administration of adenosine for termination of supraventricular tachycardia.

OBJECTIVES

This study was done to quantify the dosing differences between central and peripheral adenosine administration for treatment of supraventricular tachycardia.

BACKGROUND

Earlier studies that evaluated the safety and efficacy of adenosine primarily utilized a peripheral site of administration. Although it has been recommended that lower doses should be given centrally, dosing recommendations have not been provided.

METHODS

Thirty adults with supraventricular tachycardia underwent invasive electrophysiologic study and were treated with central and peripheral intravenous administration of adenosine. Peripheral injections were administered through a venous catheter in an upper extremity and central infusions were accomplished by means of a catheter positioned in or near the right atrium. The site of administration was randomized and each subject received adenosine by both routes. Adenosine was administered every minute in increasing increments of 3, 6, 9 and 12 mg until the tachycardia terminated. Peripheral responses were compared with those obtained centrally.

RESULTS

The minimal effective peripheral dose was distributed among the four doses: Tachycardia was terminated in 11 patients with 3 mg (37%), in 10 (33%) with 6 mg, in 4 (13%) with 9 mg and in 5 (17%) with 12 mg. In contrast, after central administration, 23 episodes of tachycardia (77%) were terminated with 3 mg, 6 (20%) with 6 mg and 1 (3%) with 9 mg; none required 12 mg. Lower doses of adenosine were more effective after central than after peripheral administration, with 63% of the subjects requiring a lesser dose. There was no difference between the two routes of drug administration in the incidence of side effects or transient arrhythmias at the time of tachycardia termination.

CONCLUSIONS

Adenosine can be safely given centrally for termination of supraventricular tachycardia. The initial dose should be 3 mg.