Adenosine is an endogenous nucleoside acting on coronary perfusion and myocardial conduction. Although the anti-arrhythmic effects of adenosine have been known for decades, interest in the use of adenosine or adenosine triphosphate (ATP- a precursor of adenosine) in termination of supraventricular tachycardia (SVT) has been renewed. We studied the use of Striadyne (ATP and a mixture of other nucleosides including adenosine) in 22 infants younger than 6 months in order to evaluate efficacy and safety of the drug in this particular age group. Striadyne stopped SVT in 17 cases and was diagnostic in another 4 cases. Ten out of 17 successfully converted infants showed one or more reinitiations of SVT, which were easily controlled. The results support the efficacy of ATP for the termination of re-entry types of tachycardia, as well as its diagnostic value and its lack of serious side-effects.
Conclusion: Adenosine or ATP could be the drug of choice for the treatment of junctional tachycardia in infants after vagal manoeuvres have failed. Provided continuous ECG monitoring is performed during injection, adenosine or ATP may be diagnostic in other types of supraventricular tachycardia and even in wide-complex tachycardia. We suggest a bolus injection of 0.5-1.0 mg/kg to be used prior to transport to the paediatric cardiology unit.