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Question 3 Does a higher initial dose of adenosine improve cardioversion rates in supraventricular tachycardia?
  1. Michael A Quail1,
  2. Jan Till2
  1. 1Cardiac Unit, Great Ormond Street Hospital, Great Ormond Street, London, UK
  2. 2Royal Brompton and Harefield NHS Foundation Trust, London, UK
  1. Correspondence to Dr Michael A Quail, Cardiac Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; michael.quail{at}googlemail.com

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Scenario

An 8-year-old girl attends the accident and emergency department complaining of palpitations and breathlessness for 1 h. An ECG confirms a diagnosis of supraventricular tachycardia (SVT). The patient is haemodynamically stable and vagal manoeuvres are ineffective. Intravenous access is obtained and a 100 µg/kg dose of adenosine is administered with persistence of SVT. A further higher dose of 200 µg/kg is administered with successful restoration of sinus rhythm.

The case is discussed with colleagues, who indicate similar initial failures with lower doses of adenosine. You wonder if choosing the higher dose initially would be more effective at re-establishing sinus rhythm?

Structured clinical question

In children with supraventricular tachycardia [patient], does high dose adenosine [intervention] compared with low dose adenosine [control] achieve higher rates of cardioversion [outcome]?

Search strategy

Secondary sources

A search of The Cochrane Library of systematic reviews and the BestBETS website identified no articles.

Primary sources

An Ovid Medline (1948–week 1 May 2011) search was performed using the search terms: Tachycardia, Supraventricular/ or Tachycardia, Atrioventricular Nodal Reentry/ or tachycardia, …

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