Review article: Adenosine use in the emergency department

Objective: To perform a review of the efficacy of adenosine, including its potential role as first-line treatment in unstable supraventricular tachycardia (SVT) and its use in wide complex tachycardias and diagnosing difficult arrhythmias. The dose and administration, nature and frequency of side-effects and relevant interactions and dosage adjustments are also discussed. Methods: A search of the Medline database from 1950 to 2007 and the Embase Database from 1974 to 2007 was carried out. A manual search was performed of references of each article. Results: Adenosine is efficacious at treating stable SVT, but it is no more effective than cheaper alternatives. It has a possible role in the first-line treatment of unstable SVT;and is generally safe and effective when used to treat and/or diagnose wide complex tachycardias. There is a small risk of inducing serious arrhythimas, such as prolonged atrioventricular blockade and ventricular fibrillation. There is evidence that recommended initial doses for infants might be too low, but initial doses for children and adults are adequate. There is evidence that central venous administration requires lower doses, but there are no studies addressing peripheral sites of administration and size of flush. Minor and self-limiting side-effects are common. The need for dosage adjustments in the presence of interacting medications is well documented, but no studies have addressed how to rationally effect these adjustments. Conclusion: There is extensive evidence showing adenosine to be efficacious at treating SVT, but no more efficacious than cheaper alternatives. More studies are required to investigate other areas of adenosine use.