Adverse Effects and Limitations of Adenosine in Treatment of Narrow QRS Complex Tachycardia (NCT) and Broad Complex Tachycardia (BCT): A Systematic Review

There has been always a need to unlock the key to a different kind of tachycardia, tachyarrhythmias, in short, Narrow complex tachycardias {which includes Atrioventricular nodal reentrant tachycardia (AVNRT), Atrioventricular reciprocating tachycardia (AVRT), Nonparoxysmal junctional tachycardia (NPJT), Orthodromic Reciprocating Tachycardia (ORT), Permanent junctional reciprocating tachycardia (PJRT)} which also lead to broad complex tachycardias, it’s appropriate management at that juncture with the consideration of all the adverse effects and limitations, with Adenosine and verapamil, while taking into consideration the contraindications of both the adenosine, the calcium channel blockers (verapamil/diltiazem) used for the chemical conversion of Supra Ventricular tachycardia (SVT) even when the accessory pathways are involved. The use of the drugs as a diagnostic tool be it the presence of latent pre-excitation, fasciculo-ventricular pathway, and unmasking the dual atrioventricular (AV) nodal physiology along with the treatment tool has also been discussed. On February 10, 2023, many databases, including PubMed, Google Scholar, and the Cochrane Library, were used to search the chosen studies. The chosen papers for this review were released up until 2014. The PRISMA flow diagram included a description of the systematic search. 6,542 articles were initially identified for the chosen databases. After the manual selection of papers and quality evaluation of the essential articles, 10 articles were ultimately picked for the thesis' foundation. Randomized Control Trials (RCTs) are evaluated for quality using the Cochrane bias assessment tool, the Prisma checklist for systematic reviews, the JB check tool for case reports, and the Newcastle Ottawa tool for non-randomized clinical trials. There are three aspects covered, which are the methods of administration, complications post-adenosine administration, and effectiveness & adverse effects of adenosine & Calcium Channel Blockers in Supra Ventricular Tachycardia. Comparison of the success rate, adverse effects, and conversion rate and its interpretation through the selected articles. Success rates for Adenosine and Verapamil are compared. Comparison of adenosine injection techniques' rates of success. Comparison of adenosine administration difficulties experienced by participants in various studies. Comparison of the issues faced by participants in several studies who took Verapamil through graphical representation. Comparatively, Adenosine has been found as the superior drug, irrespective of increased side effects due to its short half-life (approx. nine seconds) and fast conversing action, leading to an increased success rate. It can be concluded that Shortness of breath (SOB) and flushing have both significantly impacted complications. It is followed in descending order by nausea, vomiting, chest pain, bradycardia, and the remaining problems. On the other hand, side effects from taking verapamil show that hypotension is the most commonly impacted, followed by shortness of breath and other side effects