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 bet ween central and peripheral adenosine administration for treatment of supraventricular tachycardia. Background. Earlier studies that evaluat ed the safety and efficacy of adenosine primarily utilized a periphera l 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 und erwent invasive electrophysiologic study and were treated with central and peripheral intravenous administration of adenosine. Peripheral in jections were administered through a venous catheter in an upper extre mity and central infusions were accomplished by means of a catheter po sitioned in or near the right atrium. The site of administration was r andomized and each subject received adenosine by both routes. Adenosin e was administered every minute in increasing increments of 3, 6, 9 an d 12 mg until the tachycardia terminated. Peripheral responses were co mpared with those obtained centrally. Results. The minimal effective p eripheral dose was distributed among the four doses: Tachycardia was t erminated 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. Low er doses of adenosine were more effective after central than after per ipheral administration, with 63% of the subjects requiring a lesser do se. There was no difference between the two routes of drug administrat ion in the incidence of side effects or transient arrhythmias at the t ime of tachycardia termination. Conclusions. Adenosine can be safely g iven centrally for termination of supraventricular tachycardia. The in itial dose should be 3 mg.