Abstract:
OBJECTIVE:To assess the safety and efficacy of intravenous adenosine in terminating acute episodes of paroxysmal supraventricular tachycardia. DESIGN:Two prospective, double-blind, randomized, placebo-controlled trials to evaluate dose response in patients receiving adenosine and to compare the effects of adenosine with those of verapamil. PATIENTS: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. INTERVENTIONS: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 adenosine or 5 mg and, if necessary, 7.5 mg of verapamil. MEASUREMENTS AND MAIN RESULTS: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 doses 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 less than 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. CONCLUSIONS: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.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
DiMarco JP,Miles W,Akhtar M,Milstein S,Sharma AD,Platia E,McGovern B,Scheinman MM,Govier WCdoi
10.7326/0003-4819-113-2-104subject
Has Abstractpub_date
1990-07-15 00:00:00pages
104-10issue
2eissn
0003-4819issn
1539-3704journal_volume
113pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract::Six patients with rheumatoid arthritis developed a syndrome resembling lupus erythematosus while being treated with penicillamine. All patients had previous mucocutaneous reactions to chrysotherapy. Manifestations included pleurisy in five of six patients, rashes in three, nephritis in two, and neurologic disturbances...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-97-5-659
更新日期:1982-11-01 00:00:00
abstract::We performed immunohistopathologic studies on biopsied lung tissue obtained from two patients with lupus pneumonitis using immunofluorescence, immunoperoxidase, electron microscopy, and acid-microelution. In both patients, immunofluorescence showed granular deposits of IgG, the third component of complement (C3), and ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-91-1-30
更新日期:1979-07-01 00:00:00
abstract::During 1973 and 1974, we looked for cases of Colorado tick fever throughout Colorado; 228 cases were identified. Although 90% of the patients reported exposure to ticks before illness, only 52% were aware of an actual tick bite. Typical symptoms of fever, myalgia, and headache were common, but gastrointestinal symptom...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-88-3-303
更新日期:1978-03-01 00:00:00
abstract::Hepatocellular carcinoma is the most frequent cancer worldwide, responsible for approximately 1,000,000 deaths annually, most of them in the Far East and in sub-Saharan Africa. It usually presents at an advanced stage and has a poor prognosis. There is evidence of an etiologic role for hepatitis B virus infection in t...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-108-3-390
更新日期:1988-03-01 00:00:00
abstract::Two patients presented with abnormalities suggestive of pituitary adenoma; one during pregnancy and one in the postpartum period. However, pathologic examination of the pituitary showed extensive destruction by a lymphoplasmacytic infiltrate; no tumor was identified. Both patients developed hypopituitarism. We know of...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-95-2-166
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abstract:BACKGROUND:The frequency and severity of post-thrombotic sequelae after spontaneous axillary-subclavian venous thrombosis remain poorly known. OBJECTIVE:To determine the late sequelae of conventionally treated spontaneous axillary-subclavian venous thrombosis. DESIGN:Cross-sectional study. SETTING:University departm...
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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abstract::Neuroblastoma, the second commonest solid tumor in children, is a neoplasm of the peripheral autonomic nervous system that usually occurs before children are 6 years old. Therapy of localized tumor (clinical stage I and II) and of a special form of metastatic tumor (clinical stage IV-S) is usually successful, but trea...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
pub_type: 指南,杂志文章
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journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
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更新日期:2003-11-04 00:00:00
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更新日期:2008-07-15 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
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更新日期:2014-10-07 00:00:00
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journal_title:Annals of internal medicine
pub_type: 历史文章,杂志文章,评审
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更新日期:2001-05-01 00:00:00
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journal_title:Annals of internal medicine
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更新日期:2009-04-07 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:2009-09-01 00:00:00
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journal_title:Annals of internal medicine
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更新日期:1991-08-15 00:00:00
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更新日期:2020-10-05 00:00:00