Supraventricular tachycardia: adenosine and calcium channel antagonist are equivalent

SOURCE

Alabed S, Sabouni A, Providencia R, et al. (2017). Adenosine versus intravenous calcium channel antagonists for supraventricular tachycardia. Cochrane Database of Syst Rev 10:CD005154.

CONTEXT

Supraventricular tachycardia (SVT) is a common arrhythmia. Vagal maneuvres are often unsuccessful and drugs are required to terminate SVT.  Despite limited evidence, current guidelines recommend using adenosine as first-line treatment.

CLINICAL QUESTION

Should adenosine or calcium channel antagonists be used as first-line treatment to treat SVT?

BOTTOM LINE

No difference exists between the two drugs in successfully treating SVT (moderate quality evidence). There is no difference in terms of major side effects (cardiac arrest, hypotension, bradycardia requiring medical act), or relapse rate (low quality evidence). Minor adverse events like chest tightness and flushing are more frequent with adenosine occurring in 10% of all cases.

CAVEAT

This meta-analysis included a relatively small number of randomized controlled trials and enrolled subjects.The main inclusion criterion, SVT, was not well defined. Medications used (adenosine, adenosine triphosphate, verapamil and diltiazem)and administration protocols differed between studies. No studies reported patient satisfaction and future trials should consider this outcome.

AUTHOR INFORMATION

Sébastien BEROUD
Hospices civils de Lyon, CHU Lyon-Sud
Lyon, France
sebastien.beroud@chu-lyon.fr

Kirk MAGEE
Dalhousie University –QEII Health Science Center
Nova Scotia, Canada
kirk.magee@dal.ca