EFFICACY AND DIAGNOSTIC USE OF ADENOSINE IN INFANTS AND CHILDREN

In an open study a total of 53 episodes of supraventricular reentrant tachycardia in 31 infants and children were treated with intravenous a denosine at two centers. Adenosine was given as a rapid intravenous bo lus injection beginning with a dose of 0.1 mg/kg. If there was persist ence of the dysrhythmia dosage was increased in 0.05 mg/kg-steps up to a maximum dose of 0.3 mg/kg if necessary. The median dose required fo r successful termination of the tachycardias was 0.15 mg/kg. In 26 pat ients with 48 episodes of regular narrow-QRS-complex tachycardia adeno sine was used as the therapeutic agent of first choice. In all patient s a shortlasting atrioventricular block occurred within seconds after the administration of adenosine. In 42 of 48 episodes of tachycardia ( 87 %) the dysrhythmias were converted to a stable sinus rhythm. In six episodes (13 %) recurrence of the tachycardia was observed immediatel y. In five children adenosine was used for diagnostic purpose: in thre e children with wide-QRS-complex tachycardia successful termination wi th adenosine proved the supraventricular origin of the dysrhythmia. In two children with suspected atrial nutter adenosine-induced atriovent ricular block allowed identification of nutter waves in one patient wh ile in the other patient no effect of adenosine was seen. Side-effects such as flush, chest-pain or abdominal pain were frequent but mild an d only of a few seconds' duration. No influence of adenosine on blood pressure was noted. Only in one child with previously unknown sinus no de dysfunction was a relevant electrophysiologic side effect seen: a p rolonged sinus arrest with asystole of 12 seconds' duration occurred a fter adenosine administration. In those infants and children who prese nted with heart failure adenosine did not lead to aggravation of the h emodynamic state. Considering the drug's half-life of only a few secon ds and its high efficacy and safety, adenosine is likely to evolve as the drug of first choice in the acute management of supraventricular t achycardia in infants and children.