Adenosine for Supraventricular Tachycardia: Should We Skip the 6-mg Dose?

For hemodynamically stable patients with regular narrow-complex supraventricular tachycardia (SVT), current guidelines recommend 6 mg of adenosine as the initial pharmacological treatment, followed by 12 mg if the first dose fails to achieve rhythm conversion (Figure 1). However, retrospective studies consistently show better first-dose conversion rates when 12 mg is initially used instead of 6 mg.

In the first prospective observational study to examine this issue, researchers enrolled 142 hemodynamically stable adults with electrocardiography-confirmed SVT who presented to a single emergency department (ED) in Turkey. Patients received either an initial intravenous bolus of 6 mg or 12 mg of adenosine at the clinicians’ discretion.