Dexmedetomidine and Adenosine: Therapeutic Use for SVT

University of Pittsburgh22 enrolled

Overview

The purpose of this study is to evaluate the efficacy and safety of dexmedetomidine in the acute termination of Supraventricular Tachycardia (SVT).

In 2006 the investigator found that dexmedetomidine, an alpha-2 adrenergic agonist with primarily sedative properties, possesses additional anti-arrhythmic properties. So far the investigator has found that dexmedetomidine has the ability to prevent or terminate arrhythmias like atrial ectopic tachycardia (85% success) and junctional ectopic tachycardia (75% success). The most dramatic effect however was observed in the acute termination of reentrant SVT with a success rate of \> 96%. More importantly we found that dexmedetomidine terminates SVT without causing any sinus pause or asystole (frequently seen with adenosine) and thus avoiding the feeling of "impending doom". In this study adenosine is being compared head to head with dexmedetomidine in a cross over study, for both safety and efficacy when given for the termination of SVT in the electrophysiology (EP) lab. Additional EP parameters will be measured to elucidate the exact site of dexmedetomidine's mechanism of action.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Supraventricular Tachycardia

Interventions

DexmedetomidineDRUG

Dexmedetomidine 2 mcg/kg, Intravenous push

AdenosineDRUG

Stepwise incremental approach of adenosine starting at 0.2 mg/kg (max 6 mg) followed by 0.3 mg/kg (max 12 mg) if initial dose was unsuccessful

Eligibility

Sex: ALLMin age: 5 YearsMax age: 30 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients between the age of 5 - 30 years old, who are scheduled for cardiac electrophysiology study for evaluation of reentrant SVT Exclusion Criteria: * Severe Heart Failure * Presence of of any other antiarrhythmic medication within 24 hours of enrollment * Third degree heart block * Sick Sinus Syndrome

Locations (1)

Childrens Hospital of Pittsburgh of UPMC

Pittsburgh, Pennsylvania, United States

Outcomes

Primary Outcomes

Termination of SVT

Number of participants with SVT Termination within 3 minutes of medication administration

Time frame: Within 3 minutes

Secondary Outcomes

Number of Participants With Sinus Pause >2.5 Sec After Termination of SVT

Evaluation of the number of participants with sinus pause \> 2.5 sec, after dexmedetomidine vs. adenosine induced SVT termination

Time frame: 1 minute

Number of Participants With Tachyarrhythmias After Medication Administration

Number of participants with tachyarrhythmias, including Ventricular (Ventricular Tachycardia \& Fibrillation)and supraventricular (Atrial Flutter \& Fibrillation) after dexmedetomidine vs. adenosine administration

Time frame: 10 minutes

Number of Participants With Hypotension by Non-invasive Cuff in First 10 Minutes After Medication Administration

Blood pressure changes after dexmedetomidine vs. adenosine. Blood pressure measured by non-invasive cuff prior to medication administration, and then at 1 min, 3 min, 5 min after medication administration. Number of participants with a significant drop in blood pressure (mmHg) compared to baseline would be counted for hypotension.

Time frame: 10 minutes

Data from ClinicalTrials.gov

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