INTRAVENOUS ADENOSINE IN THE EMERGENCY DEPARTMENT MANGEMENT OF UNSTABLE PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA

Park, Kyu Nam; Lee, Won Jae; Lee, Ki Jung; Oh, Dong Ryul; Park, Seung Hyun; Hwang, Ju Il; Kim, Se Kyung; Im, Eung Hoon; Kang, Dong Heon; Seung, Ki Bae; Chae, Jang Sung; Choi, Kyu Bo

J Korean Soc Emerg Med > Volume 5(2); 1994 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 1994;5(2): 176-181.

INTRAVENOUS ADENOSINE IN THE EMERGENCY DEPARTMENT MANGEMENT OF UNSTABLE PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA

Kyu Nam Park¹, Won Jae Lee¹, Ki Jung Lee¹, Dong Ryul Oh¹, Seung Hyun Park¹, Ju Il Hwang¹, Se Kyung Kim¹, Eung Hoon Im², Dong Heon Kang², Ki Bae Seung², Jang Sung Chae², Kyu Bo Choi²

¹Department of Emergency Medicine, Catholic University Medical College
²Department of Internal Medicine, Catholic University Medical College

Published online: December 31, 1994.

ABSTRACT

Study purpose : To evaluate the efficacy of adenosione in the treatment of emergency department patients with unstable paroxysmal supraventricular tachycardia.
Design
A ten--months prospective outcome study. Population : Patients with 16 or more old with unstable PSVT(systolic blood pressure of less than 90mmHg, chest pain, pulmonary edema, and/or altered mental status ) by surface ECG criteria. Measurements : Patient's preadenosine and postadenosine heart rates, symptoms, and blood pressure, complications and recurrence of PSVT.
Results
: Forteen patients mets inclusion criteria. After IV adenosine, One patient was found to have atrial flutter. PSVT were diagnosed in remaining thirteen patients. There were five male and eight female patients with a mean age 35.2(range, 16-52). Six patients presents with hypotension(mean systolic blood pressure, 78.6mmHg), four with chest pain, and three with both chest pain and hypotension. There were no patients with altered mental status or pulmo nary edema. Eleven patients( 85% ) converted to sinus rhythm with adenosine therapy ( initial 6mg adenosine : eight patients, additional 12mg : three patients). The remaning two patients required electrical cardioversion. Two patients converted to sinus rhythm by electrical cardioversion. In all cases, chest pain and hypotension resolved within minutes of conversion to sinus ryhthm. There were no clinically significant adverse effects or recurence of PSVT during emergency department observation period.
Conclusion
In the unstable patient with PSVT, adenosine appears to be a safe and effective alternative to current advanced cardiac life support-recommended immediate electrical cardioversion.

Key words: Adenosine, Unstable PSVT