Effectiveness of Calcium Channel Blockers and Adenosine in the Emergency Management of SVT
Information source: Singapore General Hospital
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Supraventricular Tachycardia
Intervention: Calcium Channel Blocker & Adenosine (Drug)
Phase: Phase 4
Sponsored by: Singapore General Hospital
Official(s) and/or principal investigator(s):
Lim S Han, MBBS,FRCS, Principal Investigator, Affiliation: Department of Emergency Medicine, Singapore General Hospital
The purpose of this study is to determine the efficacy and effectiveness of calcium channel
blockers and adenosine in the treatment of Supraventricular Tachycardia.
Official title: Comparism Between Efficacy and Effectiveness Between Slow Infusion of Calcium Channel Blockers and Intravenous Bolus Adenosine in the Management of Supraventricular Tachycardia in the Emergency Department.
Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Primary outcome: Conversion to the sinus rhythm.
Recurrence of SVT
Stability of vital signs
Paroxysmal Supraventricular Tachycardia (SVT) is a common cardiac emergency encountered in
the Emergency Department. Both Calcium Channel Blockers (CCB) and Adenosine have been using
in the Management of SVT.
This study compared the efficacy and effectiveness between slow Infusion of Calcium Channel
Blockers (either Verapamil or Diltiazem) and bolus intravenous Adenosine in termination of
This was a prospective, randomised, controlled clinical trial comparing the efficacy and
effects of intravenous adenosine with slow infusion of calcium channel blockers (verapamil
or diltiazem) in patients presenting with SVT to an Emergency Department. The study was
approved by the hospital’s Ethics Committee.
Patients of at least 10 years of age, who presented to the Emergency Department of the
Singapore General Hospital with regular narrow complex tachycardia and an
electrocardiographic(ECG) diagnosis of SVT that was not converted by vagal manoeuvres
(Valsava manoeuvre or carotid sinus massage or both) and who were in SVT at the time of
doctor attendance were included in the study.
The exclusion criteria were as follows:
- Patients with signs of impaired cerebral perfusion (e. g. altered mental state) or acute
- Patients with a subsequent diagnosis of arrhythmias other than SVT (i. e. sinus
tachycardia, atrial flutter, atrial fibrillation or idiopathic ventricular tachycardia)
were excluded from the analysis if they were initially enrolled
- Pregnancy by history (urine pregnancy testing was not used to actively exclude the
condition in any of the female patients entered into the study).
Having selected the patients according to the criteria, they were randomly assigned into two
groups: one to receive calcium channel blockers and the other, Adenosine. Within the former
group, some were assigned randomly to receive Diltiazem and some to Verapamil.
Diltiazem was given at the dose of 2. 5mg per minute (4ml per minute of a concentration of
0. 625 mg/ml) up to a maximum of 50 mg. The dose of Verapamil was 1mg per minute (4ml per
minute of a concentration of 0. 25mg/ml) up to a maximum of 20mg. Both were given as a slow
intravenous infusion using a Terumo infusion pump.
During intravenous infusion, the patient’s vital signs, viz. heart rate and systolic and
diastolic blood pressures, were monitored at two-minute intervals up to completion of
infusion or conversion from SVT, whichever was the earlier. At the time of conversion to
sinus rhythm, the infusion was stopped and the amount of drug infused was noted and
Regarding the Adenosine group, all the patients were administered Adenosine as a rapid bolus
within 2 sec through an 18G IV cannula at an antecubital vein, followed by 10 ml saline
flush and elevation of the limb. Initially 6ml bolus was given rapidly, and if there was no
conversion of the SVT within 2 min, another 12 mg bolus was administered.
If SVT was not converted at the end of any of calcium channel blocker infusion, those
patients were then given intravenous Adenosine as described above. Similarly, those patients
who remained in SVT after first two initial boluses of Adenosine were again randomized to
receive either Verapamil or Diltiazem.
This allowed four orders of treatment as follows:
- Verapamil infusion followed by Adenosine
- Diltiazem infusion followed by Adenosine
- Adenosine followed by Verapamil infusion
- Adenosine followed by Diltiazem infusion
If the tachycardia was not converted at the end of the study protocol, patients were managed
either with synchronised electrical cardioversion if haemodynamically unstable or with
further pharmacotherapy at the discretion of the treating physician if vital signs were
Following the successful conversion, patients' vital signs were closely monitored at 1 min
(immediate post-conversion), 5,10, 15 min and finally 30 min of post-conversion. If they
remained stable, they were shifted to observation ward with continuous telemetric
monitoring. They were eventually discharged if there were no recurrence during the period of
observation and arranged a follow-up appointment at Arrhythmia Clinic one week later.
Patients with the recurrence of SVT during the two-hour observation period were managed at
the discretion of the treating physician.
Study end points were as follows:
- Conversion to sinus rhythm
- Withdrawal because of major adverse effects
- Completion of trial protocol without termination of tachycardia
Data on the final analysis was obtained from follow-up records of Cardiology department as
well. The cost of medication used for each patient was also computed to understand the cost
aspects of different regimens.
Minimum age: 10 Years.
Maximum age: N/A.
- More than 10 years old
- Electrocardiographic diagnosis of SVT
- SVT not converted by the vagal manoeuvres
- Signs of impaired cerebral perfusion
- Signs of pulmonary oedema
- Subsequent diagnosis of other types of arrythmias rather than SVT
- pregnancy by history
Locations and Contacts
Singapore General Hospital, Singapore 62223322, Singapore
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Starting date: January 1997
Last updated: December 19, 2006