Adenosine for wide-complex tachycardia: Efficacy and safety

Keith A. Marill, Sigrid Wolfram, Ian S. DeSouza, Daniel Nishijima, Darren Kay, Gary S. Setnik, Thomas O. Stair, Patrick T. Ellinor

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

OBJECTIVES: To determine whether adenosine is useful and safe as a diagnostic and therapeutic agent for patients with undifferentiated wide QRS complex tachycardia. The etiology of sustained monomorphic wide QRS complex tachycardia is often uncertain acutely. DESIGN: A retrospective observational study. SETTING: Treatment associated with emergency visits at nine urban hospitals. PATIENTS: Consecutive patients treated with adenosine for regular wide QRS complex tachycardia between 1991 and 2006. INTERVENTIONS: Treatment with adenosine infusion. MEASUREMENTS AND MAIN RESULTS: Measured outcomes included rhythm response to adenosine, if any, and all adverse effects. A positive response was defined as an observed change in rhythm including temporary atrioventricular conduction block or tachycardia termination. A primary adverse event was defined as emergent electrical or medical therapy instituted in response to an adverse adenosine effect. A rhythm diagnosis was made in each case. The characteristics of adenosine administration as a test for a supraventricular as opposed to ventricular tachycardia were determined, and the adverse event rates were calculated. A total of 197 patients were included: 104 (90%) of 116 (95% confidence interval, 83%-95%) and two (2%) of 81 (95% confidence interval, 0.3%-9%) supraventricular tachycardia and ventricular tachycardia patients demonstrated a response to adenosine, respectively. The odds of supraventricular tachycardia increased by a factor of 36 (95% confidence interval, 9-143) after a positive response to adenosine. The odds of ventricular tachycardia increased by a factor of 9 (95% confidence interval, 6-16) when there was no response to adenosine. The rate of primary adverse events for patients with supraventricular tachycardia and ventricular tachycardia was 0 (0%) of 116 (95% confidence interval, 0%-3%) and 0 (0%) of 81 (95% confidence interval, 0%-4%), respectively. CONCLUSIONS: Adenosine is useful and safe as a diagnostic and therapeutic agent for patients with regular wide QRS complex tachycardia.

Original languageEnglish (US)
Pages (from-to)2512-2518
Number of pages7
JournalCritical Care Medicine
Volume37
Issue number9
DOIs
StatePublished - Sep 2009

Keywords

  • Adenosine
  • Adverse effects
  • Anti-arrhythmia agents
  • Cardiovascular
  • Diagnostic techniques
  • Tachycardia, supraventricular
  • Tachycardia, ventricular

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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