Title: Comparing methods of adenosine administration in paroxysmal supraventricular tachycardia: A pilot randomized controlled trial

Abstract

Study objective: Adenosine intravenous is the recommended treatment for paroxysmal supraventricular tachycardia (PSVT). There is no official recommended method of giving adenosine. We aim to compare the success rate between the standard and alternative method of first dose intravenous adenosine in PSVT. Methods: A pilot parallel randomized controlled study was conducted in the Emergency Department (ED) of a tertiary care hospital. Eligible patients were stable PSVT patients. We used block randomization and divided them into two groups, the standard method (double syringe technique of 6 milligrams adenosine), and the alternative method (similar to standard method, then immediately followed by elevating arm to 90 degrees perpendicular to a horizontal plane for 10 seconds). Primary outcome is the success rate of electrocardiogram (ECG) response which demonstrated termination of PSVT (at least 2-fold of the RR-interval widening or sinus rhythm conversion). Secondary outcomes are complications within 1 minute after injection. Results: We allocated 15 patients in each group and analysed as intention-to-treat. The success rate was 86.7 % in the alternative group and 80% in the standard group (risk difference 6.7%, 95% confidence interval -19.9 to 33.2%, P value 1). Complications within 1 minute after adenosine injection were also similar in both groups, 14 of 15 patients (93%) in each group have no complication, without significant difference. Conclusion: No evidence difference between alternative and standard method, in terms of the success rate of ECG response and complications within 1 minute after adenosine injection. A further definitive study is required.

Biography

Phruek Daengbubpha received the Doctor of Medicine degree in 2014 from Chiang Mai university and recently graduated from Emergency Department, Faculty of Medicine, Chiang Mai University in 2021.After graduation, he has been working as Emergency Physician in Chom Thong Hospital, where is located 40 miles away from Chiang Mai. This research has done when he was training as a resident physician. Because in Thailand, they were taught to administer adenosine for SVT by elevate the arm. So, he was inspired and want to find out that is it possible if we do not elevate the arm. And what will be the result from this method.