The relative efficacy of adenosine versus verapamil for the treatment of stable paroxysmal supraventricular tachycardia in adults: a meta-analysis
Abstract
OBJECTIVE: Verapamil and adenosine are the most common agents used to treat paroxysmal supraventricular tachycardia (PSVT). We performed a systematic review and meta-analysis to determine the relative effectiveness of these drugs and to examine their respective adverse effect profiles. METHODS: We searched MEDLINE, EMBASE, CINAHL, the Cochrane database, and international clinical trial registers for randomized controlled trials comparing adenosine (or adenosine compounds) with verapamil for the treatment of PSVT in stable adult patients. The primary outcome was rate of reversion to sinus rhythm. Secondary outcome was occurrence of pooled adverse events. Odds ratios and 95% confidence intervals (CIs) were calculated using a random effects model (RevMan v5). RESULTS: Eight trials were appropriate and had the available data. The reversion rate for adenosine was 90.8% (95% CI: 87.3-93.4%) compared with 89.9% for verapamil (95% CI: 86.0-92.9%). The pooled odds ratio for successful reversion was 1.27 (95% CI: 0.63-2.57) favouring adenosine. This was not statistically significant. There was a higher rate of minor adverse effects described with adenosine (16.7-76%) compared with verapamil (0-9.9%). The rate of hypotension was lower with adenosine [0.6% (95% CI: 0.1-2.4%)] compared with verapamil [3.7% (95% CI: 1.9-6.9%)]. CONCLUSION: Adenosine and verapamil have similar efficacy in treating PSVT. Adenosine has a higher rate of minor adverse effects, and of overall adverse effects, whereas verapamil has a higher rate of causing hypotension. A decision between the two agents should be made on a case-by-case basis and ideally involve informed discussion with the patient where appropriate.
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Adenosine has advantages over IV calcium channel blockers: rapid onset, short half-life, and avoidance of hypotension.
“The advantages of adenosine relative to IV calcium channel are its rapid onset, the short half-life, and the avoidance of hypotension.71”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [71]
Intravenous adenosine bolus can terminate AVRT in the emergency room.
“In the emergency room adenosine IV bolus can terminate AVRT.71,72”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [71]
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Jolić, A., Mitov, V., Nedeljkovic, M. A., Mujović, N. M., Kostić, T. L., Adamović, D., Nikolic, M. R., & Dimitrijević, M. (2020) · Srce i krvni sudovi · doi:10.5937/siks2011031j
Taquicardia paroxística supraventricular
Guerra, M. J. G., & Costa, L. C. (2026) · Actualización en Medicina de Familia · doi:10.55783/amf.220304
Singapore Advanced Cardiac Life Support Guidelines 2026
Ong, J. W. S., Leong, B. S., Chia, Y. W., Chong, D., Fong, W. K., Foo, D. C. G., Ho, A. F. W., Oh, J. H. H., Seow, E., Sewa, D. W., et al. (2026) · Singapore Medical Journal · doi:10.4103/singaporemedj.smj-2026-280
Mureşan, L., Cismaru, G., Popa, S., Roşu, R., Guşetu, G., Puiu, M., Mada, R. O., Muresan, C., Bouar, R. L., Schiau, S., et al. (2026) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-026-00828-2
Diagnosis and management of supraventricular tachycardia
Whinnett, Z. I., Sohaib, S. M. A., & Davies, D. W. (2012) · BMJ · doi:10.1136/bmj.e7769 · Cited by 47 · see citing works
- Authors
- Delaney, B., Loy, J., & Kelly, A.-M.
- Affiliations
- Sunshine Hospital (AU)
- Corresponding author
- Kelly, Anne-Maree
- ORCID
- Kelly, Anne-Maree
- Venue
- European Journal of Emergency Medicine
- Published
- 2011-06
- Volume
- 18
- Issue
- 3
- Pages
- 148-152
- ISSN
- 0969-9546 (ISSN-L)
- OpenAlex
- W1971336706
- Cited by
- 91
- References
- 0
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 15 · 2023: 7 · 2022: 5 · 2021: 5 · 2020: 7 · 2019: 3 · 2018: 2 · 2017: 7 · 2016: 6 · 2015: 9 · 2014: 7 · 2013: 3 · 2012: 3
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- paroxysmal supraventricular tachycardia, adenosine, verapamil, sinus rhythm restoration, adverse drug reactions, hypotension, antiarrhythmic drugs, drug efficacy comparison
- MeSH terms
- Adenosine, Adult, Anti-Arrhythmia Agents, Humans, Tachycardia, Supraventricular, Verapamil, Confidence Intervals
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