Adenosine for wide-complex tachycardia: efficacy and safety.

Keith A Marill, Sigrid Wolfram, Ian S Desouza, Daniel K Nishijima, Darren Kay, Gary S Setnik, Thomas O Stair, Patrick T Ellinor

Critical Care Medicine 2009 September

OBJECTIVES: : To determine whether adenosine is useful and safe as a diagnostic and therapeutic agent for patients with undifferentiated wide QRS complex tachycardia. The etiology of sustained monomorphic wide QRS complex tachycardia is often uncertain acutely.

DESIGN: : A retrospective observational study.

SETTING: : Treatment associated with emergency visits at nine urban hospitals.

PATIENTS: : Consecutive patients treated with adenosine for regular wide QRS complex tachycardia between 1991 and 2006.

INTERVENTIONS: : Treatment with adenosine infusion.

MEASUREMENTS AND MAIN RESULTS: : Measured outcomes included rhythm response to adenosine, if any, and all adverse effects. A positive response was defined as an observed change in rhythm including temporary atrioventricular conduction block or tachycardia termination. A primary adverse event was defined as emergent electrical or medical therapy instituted in response to an adverse adenosine effect. A rhythm diagnosis was made in each case. The characteristics of adenosine administration as a test for a supraventricular as opposed to ventricular tachycardia were determined, and the adverse event rates were calculated. A total of 197 patients were included: 104 (90%) of 116 (95% confidence interval, 83%-95%) and two (2%) of 81 (95% confidence interval, 0.3%-9%) supraventricular tachycardia and ventricular tachycardia patients demonstrated a response to adenosine, respectively. The odds of supraventricular tachycardia increased by a factor of 36 (95% confidence interval, 9-143) after a positive response to adenosine. The odds of ventricular tachycardia increased by a factor of 9 (95% confidence interval, 6-16) when there was no response to adenosine. The rate of primary adverse events for patients with supraventricular tachycardia and ventricular tachycardia was 0 (0%) of 116 (95% confidence interval, 0%-3%) and 0 (0%) of 81 (95% confidence interval, 0%-4%), respectively.

CONCLUSIONS: : Adenosine is useful and safe as a diagnostic and therapeutic agent for patients with regular wide QRS complex tachycardia.