ArticleIrish journal of medical science2026
Weight-adjusted adenosine and first-dose conversion success in supraventricular tachycardia: a prospective cohort study.
Article in Irish journal of medical science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCurrent guidelines recommend a standard fixed initial dose of 6 mg adenosine for supraventricular tachycardia (SVT). However, rising obesity rates may reduce the efficacy of this fixed-dose strategy. We aimed to evaluate the impact of body weight on first-dose adenosine success and to identify an optimal weight-adjusted dose.
methodsThis prospective observational study included 155 adult SVT patients refractory to vagal maneuvers at a tertiary emergency department (ED). All patients received an initial 6 mg dose of IV adenosine. Success was defined as conversion to sinus rhythm (SR). Weight-adjusted doses (mg/kg) were compared between success and failure groups, and ROC analysis was performed to identify optimal cutoffs.
resultsThe first-dose conversion rate was 58.1%. Patients with successful conversion had significantly lower body weight (74.0 ± 14.3 kg vs. 81.9 ± 16.2 kg, p = 0.001). The weight-adjusted dose was significantly higher in the success group compared to the failure group (0.082 vs. 0.074 mg/kg, p < 0.001). ROC analysis revealed that a weight-adjusted dose ≥ 0.076 mg/kg predicted conversion with 67.8% sensitivity and 60.0% specificity. Specificity increased to 90.8% at a cutoff of ≥ 0.10 mg/kg.
conclusionOur findings suggest that the standard fixed 6 mg initial dose of adenosine may be insufficient for contemporary populations with higher body weight. A weight-adjusted initial dose, particularly targeting 0.09-0.1 mg/kg, may optimize first-dose conversion to sinus rhythm in patients with SVT.
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