ADENOSINE FOR PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA - DOSE RANGING AND COMPARISON WITH VERAPAMIL - ASSESSMENT IN PLACEBO-CONTROLLED, MULTICENTER TRIALS
ADENOSINE FOR PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA - DOSE RANGING AND COMPARISON WITH VERAPAMIL - ASSESSMENT IN PLACEBO-CONTROLLED, MULTICENTER TRIALS
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DOI：
10.7326/0003-4819-113-2-104
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发表时间：
1990-07-15
影响因子：
39.2
通讯作者：
GOVIER, WC
中科院分区：
文献类型：
--
作者：
DIMARCO, JP;MILES, W;GOVIER, WC
本研究的目的是评估静脉注射腺苷终止阵发性室上性心动过速急性发作的安全性和有效性。这项设计包括两个前瞻性、双盲、随机、安慰剂对照试验，以评估接受腺苷治疗的患者的剂量反应，并比较腺苷和维拉帕米的效果。共有359名心电图符合阵发性室上性心动过速的心动过速患者进入两个方案。随后发现有阵发性室上性心动过速以外的心律失常的患者被排除在疗效分析之外。第一个方案比较了顺序静脉推注3、6、9和12毫克腺苷与等量生理盐水的顺序剂量。在第二个方案中，患者接受6毫克和12毫克腺苷，或5毫克和7.5毫克维拉帕米。测量和主要结果显示，在符合条件的患者的累积反应数据中，静脉注射腺苷终止阵发性室上性心动过速急性发作的比例分别为35.2%、62.3%、80.2%和91.4%，最大剂量分别为3、6、9和12毫克，而对连续四次安慰剂剂量的患者分别为8.9%、10.7%、14.3%和16.1%(P<；0.0001)。在第二次试验中，如有必要，6 mg和12 mg腺苷的累积有效率分别为57.4%和93.4%，5 mg和7.5 mg的累积有效率分别为81.3%和91.4%。注射后至腺苷终止心动过速的平均时间为30秒。腺苷在36%的患者中引起不良反应，但持续时间不到1分钟，通常是轻微的。总而言之，分级剂量达12毫克的腺苷可迅速有效地终止阵发性室上性心动过速的急性发作，在阵发性室上性心动过速中，房室结是折返回路的组成部分。腺苷的总体疗效与维拉帕米相似，但起效更快。腺苷的不良反应很常见，但轻微且短暂。
The study objective was to assess the safety and efficacy of intravenous adenosine in terminating acute episodes of paroxysmal supraventricular tachycardia. The design included two prospective, double-blind, randomized, placebo-controlled trials to evaluate dose response in patients receiving adenosine and to compare the effects of adensoine with those of verapamil. A total of 359 patients with a tachycardia electrocardiographically consistent with paroxysmal supraventricular tachycardia were entered into the two protocols. Patients subsequently found to have arrhythmias other than paroxysmal supraventricular tachycardia were excluded from the efficacy analysis. The first protocol compared sequential intravenous bolus doses of 3, 6, 9, and 12 mg of adenosine to equal volumes of saline. In the second protocol, patients received either 6 mg and, if necessary, 12 mg of adensoine or 5 mg and, if necessary, 7.5 mg of verapamil. The measurements and main results show that when data are expressed in terms of cumulative response in eligible patients, intravenous adenosine terminated acute episodes of paroxysmal supraventricular tachycardia in 35.2%, 62.3%, 80.2%, and 91.4% of patients who received maximum does of 3, 6, 9, and 12 mg, respectively, in a four-dose sequence, whereas 8.9%, 10.7%, 14.3%, and 16.1% of patients responded to four sequential placebo doses (P < 0.0001). In the second trial, cumulative response rates after 6 mg followed, if necessary, by 12 mg of adenosine were 57.4% and 93.4%, and after 5 mg followed, if necessary, by 7.5 mg of verapamil were 81.3% and 91.4%. The average time after injection to termination of tachycardia by adenosine was 30 seconds. Adenosine caused adverse effects in 36% of patients, but they lasted less than 1 minute and were usually mild. In conclusion, adenosine in graded doses up to 12 mg rapidly and effectively terminates acute episodes of paroxysmal supraventricular tachycardia in which the atrioventricular node is an integral part of the re-entrant circuit. The overall efficacy of adenosine is similar to that of verapamil, but its onset of action is more rapid. Adverse reactions to adenosine are common but are minor and brief.