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Treatment of Out‐of‐hospital Supraventricular Tachycardia: Adenosine vs Verapamil
Author(s) -
Jr. William J. Brady,
DeBehnke Daniel J.,
Wickman Lauri L.,
Lindbeck George
Publication year - 1996
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1996.tb03467.x
Subject(s) - medicine , supraventricular tachycardia , verapamil , sinus rhythm , adenosine , anesthesia , tachycardia , cardioversion , cardiology , ventricular tachycardia , bradycardia , heart rate , blood pressure , atrial fibrillation , calcium
Objective: To compare the use of adenosine and the use of verapamil as out‐of‐hospital therapy for supraventricular tachycardia (SVT). Methods: A period of prospective adenosine use (March 1993 to February 1994) was compared with a historical control period of verapamil use (March 1990 to February 1991) for SVT. Data were obtained for SVT patients treated in a metropolitan, fire‐department‐based paramedic system serving a population of approximately 1 million persons. Standard drug protocols were used and patient outcomes (i.e., conversion rates, complications, and recurrences) were monitored. Results: During the adenosine treatment period, 105 patients had SVT; 87 (83%) received adenosine, of whom 60(69%) converted to a sinus rhythm (SR). Vagal maneuvers (VM) resulted in restoration of SR in 8 patients (7.6%). Some patients received adenosine for non‐SVT rhythms: 7 sinus tachycardia, 18 atrial fibrillation, 7 wide‐complex tachycardia (WCT), and 2 ventricular tachycardia; no non‐SVT rhythm converted to SR and none of these patients experienced an adverse effect. Twenty‐five patients were hemodynamically unstable (systolic blood pressure < 90 mm Hg), with 20 receiving drug and 13 converting to SR; 8 patients required electrical cardioversion. Four patients experienced adverse effects related to adenosine (chest pain, dyspnea, prolonged bradycardia, and ventricular tachycardia). In the verapamil period, 106 patients had SVT; 52 (49%) received verapamil (p < 0.001, compared with the adenosine period), of whom 43 (88%) converted to SR (p = 0.11). Two patients received verapamil for WCT; neither converted to SR and both experienced cardiovascular collapse. VM resulted in restoration of SR in 12 patients (11.0%) (p = 0.52). Sixteen patients were hemodynamically unstable, with 5 receiving drug (p = 0.005) and 5 converting to SR; 9 patients required electrical cardioversion (p = 0.48). Four patients experienced adverse effects related to verapamil (hypotension, ventricular tachycardia, ventricular fibrillation). Recurrence of SVT was noted in 2 adenosine patients and 2 verapamil patients in the out‐of‐hospital setting and in 23 adenosine patients and 15 verapamil patients after ED arrival, necessitating additional therapy (p = 0.48 and 0.88, for recurrence rates and types of additional merapies, respectively). Hospital diagnoses, outcomes, and ED dispositions were similar for the 2 groups. Conclusion: Adenosine and verapamil were equally successful in converting out‐of‐hospital SVT in patients with similar etiologies responsible for the SVT. Recurrence of SVT occurred at similar rates for the 2 medications. Rhythm misidentification remains a common issue in out‐of‐hospital cardiac care in this emergency medical services system.