Adenosine versus verapamil for the treatment of supra-ventricular tachycardia: Randomized comparative trail

Objective: to compare the relative effects of adenosine versus intravenous verapamil in the emergency treatment of supraventricular tachycardia (svt),and to determine which is the most appropriate for the management of svt. patients and method: we performed a prospective comparative study in 180 patients from january 11,2010 to june 20,2010. comparison was made between 90 svt patients receiving adenosine and another 90 svt patients receiving verapamil. in adenosine group,initially 6 mg bolus was administered,and if it fails to cardiovert with in 2 minutes of the administration,a further 12 mg bolus was administered. if svt persisted then the patient were shifted to verapamil group. on the other hand in verapamil group,patients were given intravenous verapamil 5 mg bolus over 2 minutes and another 5 mg repeated after 10 minutes of the initial dose if the svt persisted. if verapamil fails to cardiovert then the patients were shifted to adenosine group. heart rate and blood pressure was continuously monitored during drug infusion and for up to 30min post-conversion. results: a total of 180 patients with spontaneous stable svt were analyzed. of these,in adenosine group,54 (60%) patients were cardioverted to sinus rhythm with 6 mg bolus and 17(18.89%) patients converted to sinus rhythm with an additional 12 mg bolus of adenosine. total efficacy of adenosine was 78.9%. in verapamil group,74(82.22%) patients were converted to sinus rhythm with 5 mg dose and 8(8.89%) patients converted to sinus rhythm with an additional 5 mg dose of verapamil. total efficacy of verapamil was 91.1%. test of proportion was applied and it was found that there was statistically significant difference in efficacy of verapamil as compared to adenosine (p value 0.02). conclusions: this study documents effectiveness of verapamil over adenosine in converting stable spontaneous svt to sinus rhythm. and thus,verapamil is an alternative to adenosine in the emergency treatment of svt. it is safe and affordable for healthcare systems where the availability of adenosine is limited.