Predictors of Adenosine-Induced Sinus Pause Duration for Supraventricular Tachycardia in the Emergency Department: The Role of Body Mass Index and Symptom Duration
Journal of Emergency Medicine, cilt.87, ss.122-130, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 87
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.jemermed.2026.04.034
- Dergi Adı: Journal of Emergency Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO)
- Sayfa Sayıları: ss.122-130
- Anahtar Kelimeler: Adenosine, Body mass index, Emergency department, Sinus pause, Supraventricular tachycardia
- Kütahya Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background Intravenous adenosine is the standard first-line therapy for stable supraventricular tachycardia (SVT). However, transient post-cardioversion sinus pauses frequently complicate its use, causing clinical anxiety. Patient-specific factors driving this variable duration remain poorly defined. Objective To evaluate how specific patient characteristics—namely age, body mass index (BMI), and symptom duration—independently predict adenosine-induced sinus pause duration. Methods We retrospectively analyzed adult emergency department patients with SVT successfully cardioverted with adenosine. Demographics, BMI, symptom duration, and dosing were recorded. Longest post-cardioversion sinus pauses were measured electronically. Multivariate linear regression identified independent predictors of pause duration. Results Among 89 included patients (mean age 53.7 ± 14.7 years), multivariate analysis identified age ( p = 0.022), BMI ( p = 0.031), and symptom duration ( p = 0.048) as significant independent predictors. Advanced age and prolonged symptoms correlated with longer pauses. Conversely, obese patients (BMI ≥ 30 kg/m²) exhibited significantly shorter pauses than non-obese patients (1176 ± 530 vs. 1770 ± 970 ms; p = 0.004). Initial versus cumulative adenosine doses showed no significant difference in pause duration. Conclusion Post-adenosine sinus pause duration is physiologically driven. Advanced age and prolonged tachycardia predispose patients to extended asystole, whereas obesity shortens pauses, likely due to intravascular dilution. Emergency physicians should anticipate longer pauses in elderly, lean patients with prolonged symptoms and offer appropriate pre-procedural counseling.