Elsevier

American Heart Journal

Volume 123, Issue 6, June 1992, Pages 1543-1549
American Heart Journal

Adenosine versus verapamil in the treatment of supraventricular tachycardia: A randomized double-crossover trial

https://doi.org/10.1016/0002-8703(92)90807-8Get rights and content

Abstract

The safety and efficacy of verapamil and adenosine in the acute termination of supraventricular tachycardia were compared in a randomized double-crossover trial. Of 32 eligible patients with either spontaneous or induced narrow complex tachycardia, seven (22%) patients experienced conversion to sinus rhythm with carotid sinus massage. The other 25 patients were randomly assigned to receive either adenosine (n = 14) or verapamil (n = 11). Relative drug efficacies were 100% for adenosine versus 73% for verapamil, p = NS. Adenosine given at ≤120 μg/kg caused conversion in 12 (86%) of 14 patients. The other two patients required 20 mg adenosine for conversion. After conversion the systolic blood pressure increased significantly in the adenosine group but not in the verapamil group. Reinitiation of tachycardia occurred in two (14%) of 14 patients randomized to the adenosine group. Serious adverse hemodynamic effects were observed in one (9%) of 11 patients randomized to verapamil. The incidence of conversion arrhythmias was similar in both treatment groups (adenosine 57%, verapamil 50%, p = NS).

References (41)

  • MJ Griffith et al.

    Adenosine in the diagnosis of broad complex tachycardia

    Lancet

    (1988)
  • D Mehta et al.

    Relative efficacy of various physical manoeuvres in the termination of junctional tachycardia

    Lancet

    (1988)
  • HC Meredith et al.

    Development of ventricular tachycardia following carotid sinus stimulation in paroxysmal supraventricular tachycardia

    Am Heart J

    (1950)
  • SL Winters et al.

    Verapamil-induced polymorphous ventricular tachycardia

    J Am Coll Cardiol

    (1985)
  • L Belardinelli et al.

    The cardiac effects of adenosine

    Prog Cardiovasc Dis

    (1989)
  • BN Singh et al.

    Calcium antagonists: clinical use in the treatment of arrhythmias

    Drugs

    (1983)
  • JG Klein et al.

    Comparison of the electrophysiologic effects of intravenous and oral verapamil in patients with paroxysmal supraventricular tachycardia

    Am J Cardiol

    (1982)
  • ME Benaim

    Asystole after verapamil [Letter]

    Br Med J

    (1972)
  • HO Klein et al.

    The acute hemodynamic effects of intravenous verapamil in coronary artery disease

    Circulation

    (1983)
  • CR Kirk et al.

    Cardiovascular collapse after verapamil in supraventricular tachycardia

    Arch Dis Child

    (1987)
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    Supported by National Heart Foundation of New Zealand grant 525 and The Hawke's Bay Medical Research Foundation, New Zealand.

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