Details of the Study
Supraventricular tachycardia (SVT) is a dysrhythmia originating above the atrioventricular (AV) node resulting in a narrow QRS complex (<120 milliseconds [mS]) tachycardia (>100 beats per minute [bpm]). SVT accounts for over 50,000 emergency department (ED) visits per year. Of patients with regular, narrow-complex SVT, the mainstay of therapy includes AV-nodal antagonists including adenosine and non-dihydropyridine calcium channel antagonists.
Adenosine is recommended over diltiazem and verapamil as first-line treatment of SVT. Despite existing guideline recommendations, diltiazem has become a frequently utilized choice for treatment of SVT in the ED due to its lower incidence of hypotension compared to verapamil, as well as possible increased patient tolerance and ease of administration when compared to adenosine. There is a current gap in literature regarding direct comparison of adenosine and diltiazem for management of stable SVT.
Therefore, this study sought to evaluate the patient and clinician’s experience when each medication is used as a first-line agent for SVT. Also, the efficacy (including influence of adenosine administration technique) and safety of both medications are assessed as there is clinical equipoise for management of stable SVT.
Research Aims
Aim 1: To describe participant and experience with receipt of adenosine or diltiazem for stable SVT in the ED. This aim will be accomplished through prospectively administered surveys, including: 1. Medication satisfaction survey, 2. Medication side effect survey, and 3. Perceived threat survey to patients after treatment of SVT in the ED. These surveys will quantify patient-reported symptoms within 1 hour of SVT treatment in the ED and qualitatively describe patient perception of medication side effects.
Aim 2: To compare efficacy and safety of adenosine and diltiazem for treatment of SVT in the ED. Efficacy outcomes will include rates of SVT attenuation at 15, 30, and 60 minutes, as well as time to SVT attenuation after medication administration. SVT attenuation will be defined as heart rate (HR)<100 in normal sinus rhythm. Safety outcomes will include incidence of hypotension, bradycardia, and need for rescue medication.
Aim 3: To describe clinician experience with use of adenosine and/or diltiazem for stable SVT in the ED. Clinicians directly involved in the management of SVT will be surveyed after participant enrollment to assess 1. Clinician comfort with the medication used for SVT treatment, 2. Clinician satisfaction with medication used, and 3. Perceived side effects or adverse events attributable to the medication.
Significance
As patient care becomes more specialized and directed towards patient-centered outcomes, consideration of minimizing untoward adverse effects is important, even in the emergent setting. The goal of this study is to describe the patient-perception and clinician-perception of adenosine vs diltiazem for SVT in the ED. Additionally, prospective quantitative evidence related to drug efficacy and safety could help inform guideline recommendations for the pharmacotherapeutic management of SVT.