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Crit Care Med. 2009 Sep;37(9):2512-8. doi: 10.1097/CCM.0b013e3181a93661.

Adenosine for wide-complex tachycardia: efficacy and safety.

Author information

  • 1Department of Emergency Medicine (KAM), Massachusetts General Hospital, Boston, MA, USA. kmarill@partners.org

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.

PMID:
19623049
[PubMed - indexed for MEDLINE]
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