Abstract 10459: Adenosine versus Diltiazem in Stable Supraventricular Tachycardia Unresponsive to Vagal Maneuver

Abstract

Introduction: The treatment of stable supraventricular tachycardia (SVT) in the emergency department includes intravenous adenosine. There is evidence to show that calcium channel blockers such as diltiazem have a better conversion rate. This study was conducted to determine the relative effectiveness and to examine the adverse effects of these drugs on converting stable SVT into sinus rhythm. Methods: A prospective randomized controlled study with one group receiving an intravenous bolus dose of 6mg adenosine followed by 12mg if conversion not achieved, and followed by diltiazem if not reverted, and other group receiving diltiazem 0.25mg/kg IV followed by 0.35mg/kg if conversion is not achieved which was followed by continuous infusion. Heart rate and blood pressures were continuously monitored for 1-hour post-conversion with monitoring of other adverse events results: A total of 52 patients with stable SVT were enrolled and were randomized into two groups. Of these 26 patients were given IV Adenosine in one arm and 26 patients were given IV Diltiazem. The conversion rates with adenosine 76.9% were statistically lesser than the diltiazem group 100% with the statistically significant p value of 0.023. The mean change in the blood pressures in either group was statistically insignificant and also the adverse events in either group had no significance. Conclusion: Calcium channel blockers such as diltiazem may be superior to adenosine in the emergency department in the treatment of stable SVT. In this study IV Diltiazem had better conversion rates than the IV adenosine bolus with minimal adverse events. Hence calcium channel blockers are found to be better, safe, and cost-effective in converting stable SVT.