RAGEback: Minh Le Cong, Verapamil and SVT

Summary: The discussion of verapamil as an option for the treatment of supraventricular tachycardia (SVT) in RAGE Session Two went off like a fire cracker in the FOAM world. In this RAGEback, Minh Le Cong from the PHARM podcast explains why the RAGE discussion is not going to change his practice, which is to use adenosine as a first line agent. This is followed by a response by RAGErs Karel and Cliff. You — the listener — are left to make up your own mind about which patients (if any) you’ll consider verapamil as an option. References and Links Minh cites these references (in the order they were mentioned): * Leitner RP, Hawker RE, Celermajer JM. Intravenous verapamil in the treatment of paroxysmal supraventricular tachycardia in children. Aust Paediatr J. 1983 Mar;19(1):40-4. PubMed PMID: 6870700. * Delaney B, Loy J, Kelly AM. The relative efficacy of adenosine versus verapamil for the treatment of stable paroxysmal supraventricular tachycardia in adults: a meta-analysis. Eur J Emerg Med. 2011 Jun;18(3):148-52. doi: 10.1097/MEJ.0b013e3283400ba2. Review. PubMed PMID: 20926952. * Hood MA, Smith WM. Adenosine versus verapamil in the treatment of supraventricular tachycardia: a randomized double-crossover trial. Am Heart J. 1992 Jun;123(6):1543-9. PubMed PMID: 1595533. * Anugwom C, Sulangi S, Dachs R. Adenosine vs. calcium channel blockers for supraventricular tachycardia. Am Fam Physician. 2007 Jun 1;75(11):1653-4. Review. PubMed PMID: 17575655. [Free Full Text] * Brady WJ Jr, DeBehnke DJ, Wickman LL, Lindbeck G. Treatment of out-of-hospital supraventricular tachycardia: adenosine vs verapamil. Acad Emerg Med. 1996 Jun;3(6):574-85. PubMed PMID: 8727628. Karel and Cliff added these to the mix: * Holdgate A, Foo A. WITHDRAWN: Adenosine versus intravenous calcium channel antagonists for the treatment of supraventricular tachycardia in adults. Cochrane Database Syst Rev. 2012 Feb 15;2:CD005154. doi: 10.1002/14651858.CD005154.pub3. Review. PubMed PMID: 22336809. [Free Full Text] (note: withdrawn by the author due to lack of time and resources to update) * Miyagawa K, Dohi Y, Ogihara M, Sato K. Administration of intravenous calcium before verapamil to prevent hypotension in elderly patients with paroxysmal supraventricular tachycardia. J Cardiovasc Pharmacol. 1993 Aug;22(2):273-9. PubMed PMID: 7692169. * Riaz R, Mishra J, Hussain S, Sinha LM. Adenosine Versus Verapamil for the Treatment of Supra-ventricular Tachycardia: Randomized Comparative Trial. Pakistan J Med & Health Sci. 2012 Jul-Sept [Free Full Text] * Lapage MJ, Bradley DJ, Dick M 2nd. Verapamil in infants: an exaggerated fear? Pediatr Cardiol. 2013 Oct;34(7):1532-4. doi: 10.1007/s00246-013-0739-8. Epub 2013 Jun 26. PubMed PMID: 23800976. Roie Tal’s Prezi journal club presentation on the Lapage et al 2013 article: The links mentioned at the end are: * ERCAST.org — How to run a code (2014) (includes Anand Swaminathan’s discussion of using calcium chan...