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Adenosine for Paroxysmal Supraventricular Tachycardia: Dose Ranging and Comparison with Verapamil
Assessment in Placebo-Controlled, Multicenter Trials
- John P. DiMarco, MD, PhD;
- William Miles, MD;
- Masood Akhtar, MD;
- Simon Milstein, MD;
- Arjun D. Sharma, MD;
- Edward Platia, MD;
- Brian McGovern, MD;
- Melvin M. Scheinman, MD; and
- William C. Govier, MD, PhD
Abstract
Objective: To assess the safety and efficacy of intravenous adenosine in terminating acute episodes of paroxysmal supraventricular tachycardia.
Design: Two prospective, double-blind, randomized, placebo-controlled trials to evaluate dose response in patients receiving adenosine and to compare the effects of adenosine with those of verapamil.
Patients: A total of 359 patients with a tachycardia electrocardiographically consistent with paroxysmal supraventricular tachycardia were entered into the two protocols. Patients subsequently found to have arrhythmias other than paroxysmal supraventricular tachycardia were excluded from the efficacy analysis.
Interventions: The first protocol compared sequential intravenous bolus doses of 3, 6, 9, and 12 mg of adenosine to equal volumes of saline. In the second protocol, patients received either 6 mg and, if necessary, 12 mg of adenosine or 5 mg and, if necessary, 7.5 mg of verapamil.
Measurements and Main Results: When data are expressed in terms of cumulative response in eligible patients, intravenous adenosine terminated acute episodes of paroxysmal supraventricular tachycardia in 35.2%, 62.3%, 80.2%, and 91.4% of patients who received maximum doses of 3, 6, 9, and 12 mg, respectively, in a four-dose sequence, whereas 8.9%, 10.7%, 14.3%, and 16.1% of patients responded to four sequential placebo doses (P < 0.0001). In the second trial, cumulative response rates after 6 mg followed, if necessary, by 12 mg of adenosine were 57.4% and 93.4%, and after 5 mg followed, if necessary, by 7.5 mg of verapamil were 81.3% and 91.4%. The average time after injection to termination of tachycardia by adenosine was 30 seconds. Adenosine caused adverse effects in 36% of patients, but they lasted less than 1 minute and were usually mild.
Conclusions: Adenosine in graded doses up to 12 mg rapidly and effectively terminates acute episodes of paroxysmal supraventricular tachycardia in which the atrioventricular node is an integral part of the re-entrant circuit. The overall efficacy of adenosine is similar to that of verapamil, but its onset of action is more rapid. Adverse reactions to adenosine are common but are minor and brief.
Article and Author Information
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↵* Other institutions and all of the investigators involved with The Adenosine for PSVT Study Group are listed at the end of this article. For current author addresses, see end of text.
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Grant Support: In part by a grant from Medco Research, Los Angeles, California.
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Requests for Reprints: John P. DiMarco, MD, PhD, Cardiology Division, Box 158, University of Virginia Health Sciences Center, Charlottesville, VA 22908.
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Current Author Addresses: Dr. DiMarco: Cardiology Division, Box 158, University of Virginia Health Sciences Center, Charlottesville, VA 22908.
Dr. Miles: Krannert Institute of Cardiology, 1001 West 10th Street, Indianapolis, IN 46202.
Dr. Akhtar: Mount Sinai Medical Center, University of Wisconsin School of Medicine, 950 North 12th Street, Milwaukee, WI 53233.
Dr. Milstein: University of Minnesota Hospital, Box 508, Minneapolis, MN 55455.
Dr. Sharma: 3941 J Street, Suite 260, Sacramento, CA 95819.
Dr. Platia: Washington Hospital Center, 110 Irving Street, NW, NA1045, Washington, D.C. 20010.
Dr. McGovern: Massachusetts General Hospital, Cardiac Unit, Boston, MA 02114.
Dr. Scheinman: University of California, San Francisco, Medical Center, Room 312, Moffitt Hospital, Box 0214, San Francisco, CA 94143.
Dr. Govier: Medco Research, Inc., 8744 Beverly Boulevard, Suite 404, Los Angeles, CA 90048.
- © 1990 American College of Physicians
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