Adenosine or verapamil for the acute treatment of supraventricular tachycardia?

Article Abstract:

Supraventricular tachycardia is a rapid heart rhythm, which often produces dizziness or fainting, chest discomfort or shortness of breath. The emergency room treatment of choice has for several years been the intravenous administration of the drug verapamil. A new drug, adenosine, has recently been approved for intravenous use in cases of supraventricular tachycardia, but the preferred drug has not yet been established. Both have a greater than 90 percent success rate in aborting supraventricular tachycardia, and both are reasonably safe. Verapamil can cause a low blood pressure or worsen congestive heart failure, but neither of these side effects has been reported with adenosine. Adenosine has an extremely short duration of action, generally being cleared by the body within one minute of administration, thus reducing the length of time of side effects. Adenosine has been used safely in children and infants, but its safety in other patient groups is not known. Adenosine does cause shortness of breath, chest discomfort and flushing, but these side effects are transient. Of importance is the fact that a single dose of adenosine costs $15, while a single dose of verapamil costs $0.25. Typically, two doses of adenosine and two and a half doses of verapamil are necessary to abort the arrhythmia, making adenosine 60 times as expensive as verapamil. Thus, while adenosine shows promise, current data do not warrant its replacement of verapamil as first-line therapy for supraventricular tachycardias. (Consumer Summary produced by Reliance Medical Information, Inc.)

Adenosine, Supraventricular tachycardia, editorial, Verapamil

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Propafenone treatment of symptomatic paroxysmal supraventricular arrhythmias: a randomized, placebo-controlled, crossover trial in patients tolerating oral therapy

Article Abstract:

Certain abnormal heart rhythms that occur only intermittently are called paroxysmal supraventricular arrhythmias. Few well-controlled trials of drugs to treat these arrhythmias have been conducted to date. Propafenone, a new agent, was recently approved and was the subject of a recent study. Thirty-three patients with either paroxysmal supraventricular tachycardia or paroxysmal atrial fibrillation, a related arrhythmia, were randomly assigned to receive either propafenone or placebo, and the period of time before they experienced symptoms of a recurrence of their arrhythmias was assessed. The results show that those patients receiving propafenone experienced only one-fifth as many of their arrhythmias as those receiving placebo. However, 11 patients dropped out of the study due to negative events, which were often heart-related. Nine of these eleven were in the atrial fibrillation group. The interpretation of the study results must be weighed against the design of the study. By permitting dropout before the study was completed, propafenone's efficacy was probably exaggerated, as were its adverse effects. The conclusion drawn from the findings is that those patients who tolerate propafenone therapy for their arrhythmias will probably benefit from it. (Consumer Summary produced by Reliance Medical Information, Inc.)

Arrhythmia, Propafenone, Paroxysmal tachycardia

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