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Background <p>Current guidelines recommend a standard fixed initial dose of 6 mg adenosine for supraventricular tachycardia (SVT).&#xa0;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.</p> Methods <p>This prospective observational study included 155 adult SVT patients refractory to vagal maneuvers at a tertiary emergency department (ED).&#xa0;All patients received an initial 6 mg dose of IV adenosine.&#xa0;Success was defined as conversion to sinus rhythm (SR).&#xa0;Weight-adjusted doses (mg/kg) were compared between success and failure groups, and ROC analysis was performed to identify optimal cutoffs.</p> Results <p>The first-dose conversion rate was 58.1%.&#xa0;Patients with successful conversion had significantly lower body weight (74.0 ± 14.3 kg vs. 81.9 ± 16.2 kg, p = 0.001).&#xa0;The weight-adjusted dose was significantly higher in the success group compared to the failure group (0.082 vs. 0.074 mg/kg, p &lt; 0.001).&#xa0;ROC analysis revealed that a weight-adjusted dose ≥ 0.076 mg/kg predicted conversion with 67.8% sensitivity and 60.0% specificity.&#xa0;Specificity increased to 90.8% at a cutoff of ≥ 0.10 mg/kg.</p> Conclusion <p>Our findings suggest that the standard fixed 6 mg initial dose of adenosine may be insufficient for contemporary populations with higher body weight.&#xa0;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.</p>

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Weight-adjusted adenosine and first-dose conversion success in supraventricular tachycardia: a prospective cohort study

  • 期刊论文

  • 发表日期：

    2026年7月4日

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  • Merve Osoydan Satici,
  • Gökhan Aksel,
  • Mehmet Muzaffer İslam,
  • Fahriye Naz Erdil Gündüz,
  • Dilşa Tarakçıoğlu,
  • Nevin Eker,
  • Burak Küka,
  • Alper Reşit Gündüz,
  • Ahmed Güneş,
  • Muhammed Arda Anıl,
  • Ceyda Altın,
  • Serkan Emre Eroğlu

摘要

Background

Current 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.

Methods

This 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.

Results

The 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.

Conclusion

Our 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.