• Jung Heon Kim, Jae Yun Jung, Se Uk Lee, Joong Wan Park, and Jea Yeon Choi.
• Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea(1); Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
• Am J Emerg Med. 2020 Nov 1; 38 (11): 2291-2296.

ObjectivesTo study the association of time intervals on adenosine therapy with the occurrence of refractory supraventricular tachycardia (SVT) in children.MethodsWe reviewed 334 episodes of presumed SVT requiring adenosine in children (<18 years) who visited 4 academic hospital emergency departments (EDs) from July 2013 through June 2017. Refractory SVT was defined as an SVT episode persisting after 2 doses of adenosine. Clinical and electrocardiographic findings, and symptom-to-adenosine (symptom-to-ED plus ED-to-adenosine) time of refractory and responsive SVT episodes were compared. Multivariable logistic regression was performed to identify factors associated with the occurrence of refractory SVT.ResultsOf 211 SVT episodes, 42 episodes of refractory SVT (19.9%) were noted (overall sinus conversion rate, 79.6%). The refractory episodes were associated with a higher frequency of known structural heart diseases (9.5% vs. 1.8%; P = 0.030) and a longer median ED-to-adenosine time (15.5 vs. 11.0 min; P = 0.018). The association of the ED-to-adenosine time with refractory SVT remained significant after adjustment (for increment of 1 min; aOR, 1.02; 95% CI, 1.007-1.04).ConclusionsDelayed adenosine therapy is associated with the occurrence of refractory SVT in children, supporting the need for prompt adenosine therapy.Copyright © 2019 Elsevier Inc. All rights reserved.

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