Adenosine Therapy for Supraventricular Tachycardia

Introduction to Adenosine Therapy

The American Heart Association recommends adenosine as the first-line treatment for hemodynamically stable patients with supraventricular tachycardia (SVT), with a success rate of approximately 93% 1, 2

For a hemodynamically stable patient presenting with regular tachycardia at 150-170 bpm, adenosine is the drug of choice for initial treatment, according to the British Journal of Sports Medicine 1, 2, 3
A patient is considered hemodynamically stable if they have adequate perfusion, no signs of shock, acute altered mental status, or ischemic chest pain, as defined by the Praxis Medical Insights 3
The regular rhythm at this rate strongly indicates AV nodal re-entrant tachycardia or another form of SVT, making adenosine the optimal first-line agent, as stated by the British Journal of Sports Medicine 1, 2, 3

Adenosine is the drug of choice for terminating AV nodal re-entrant tachyarrhythmias because it selectively blocks AV nodal conduction with a high success rate, according to the British Journal of Sports Medicine 1, 2
Adenosine has an extremely short half-life, making adverse effects transient, as reported by the British Journal of Sports Medicine 1, 2
Adenosine does not cause depression of myocardial contractility, unlike calcium channel blockers, as stated by the British Journal of Sports Medicine 1, 4

The initial dose of adenosine is 6 mg rapid IV push followed immediately by saline flush, as recommended by the British Journal of Sports Medicine 1, 2, 3
If no effect after 1-2 minutes, a 12 mg rapid IV push is administered, according to the British Journal of Sports Medicine 1, 2, 3

Adenosine must be administered in a monitored environment due to the risk of transient complete heart block, as warned by the British Journal of Sports Medicine 1, 2, 4
Bronchospasm can occur, particularly in asthmatic patients, which is a contraindication for adenosine, as reported by the British Journal of Sports Medicine 1, 2

Delaying treatment to obtain a 12-lead ECG is not recommended if the patient is stable and the rhythm is clearly regular narrow-complex tachycardia, as advised by the Praxis Medical Insights 3
Adenosine should be avoided if the rhythm is irregular or if pre-excitation (Wolff-Parkinson-White) is suspected, as it may precipitate ventricular tachycardia/fibrillation, according to the British Journal of Sports Medicine 1, 4, 3