Efficacy And Safety Of Adenosine Versus Verapamil In The Treatment Of Supraventricular Tachycardia

Background and Problem

Title: Efficacy And Safety of Adenosine Versus Verapamil in The Treatment of Supraventricular Tachycardia

This is an evidenced-based-study which will focus on finding the most effective intervention that often used in the treatment of heart disorder like Supraventricular Tachycardia (SVT). Supraventricular tachycardia is one type of cardiac disorder where the heart beat is very irregular and quick. The patients of SVT often experience an abnormally erratic or rapid heartbeat in the upper chambers of the heart (Patti & Ashurst, 2017). Various studies reported that SVT can be managed effectively with using proper medication or certain actions that reduce the heart rate. The medications that can be used in such case are adenosine or verapamil (Helton, 2015). The first medication is Adenosine, that injected as intravenous (IV) bolus and yields transient atrioventricular nodal block. The significant portion of paroxysmal supraventricular tachycardias, that include the atrioventricular node within every re-entrant circuit, can be converted to sinus rhythm with this (Singh & McKintosh, 2021). Verapamil, on the other hand, is still the most commonly recommended calcium antagonist for the management of cardiac arrhythmias. This is the most effective and powerful medication for paroxysmal supraventricular tachycardia, especially circus motion tachycardia both with and without pre-excitation (Shaker et al., 2015). In this study, the focus would be on finding the efficacy of Adenosine and comparing with the efficiency of verapamil and the comparison would be done by developing a specific research question following PICO format. Following the literature review the theoretical context of mechanism of both of the drug, the proposed solution (choice of drug), implementation (promotion of the chosen drug), evaluation and dissemination would also be included in this study.  

The problem in this context is Supraventricular tachycardia. Supraventricular tachycardia (SVT) can be triggered by a variety of factors, including improper diets, increasing body weight, as well as an insufficient physical activity, all of which can lead to an increase in body mass (Mahtani & Nair, 2019). SVT can be resulted in by a different type of health conditions, including coronary artery disease and prior cardiac arrest. SVT might also be caused by a past surgical condition. Arrhythmias, atrial fibrillation, congenital cardiac issues, cardiomyopathy, restricted arteries, and thyroid conditions can all cause SVT in those who have cardiovascular illness (mayoclinic.org, 2021). SVT initially originate above the ventricles of the heart (supraventricular) in the atrioventricular (AV) node present in two upper chambers. Understanding how the heart beats can help you comprehend how this happens (Mahtani & Nair, 2019). A biological pacemaker (the sinus node) in the right upper chamber ordinarily regulates the heart’s rhythm (atrium). Each heartbeat is generally started by electrical signals sent forth by the sinus node. The atria receive electrical signals, which cause the heart muscles to contract as well as pump blood into the ventricles. The signals then make their way to the AV node. The electrical signals are slowed by the AV node (mayoclinic.org, 2021). This small pause permits blood to fill the lower heart chambers. The decreased heart chambers contract as electrical signals reach the muscles of the ventricles, pumping blood from the lungs or the rest of the body. When the heart’s electrical connections become faulty that time the beats become irregular and SVT occurs. As an outcome, the individual may feel light-headed or dizzy since the brain failed to get oxygen supply.

Research Question and Methods

To conduct a literature review or evidenced-based-practice it is crucial to develop a specific research question. The format which is used in this context is PICO format (Amir-Behghadami & Janati, 2020). In this format P stands for Problem or the Population. In this study ‘P’ is Supraventricular Tachycardia among elderly population. The following is ‘I’ that represents intervention and, in this study, it is Adenosine which is used in SVT treatment. ‘C’ is the comparison with other intervention which is Verapamil in this context, that also popular in treating PSVT. Lastly ‘O’ is the outcome and the focus would be effectiveness in treating Supraventricular tachycardia. 

The evidences or literature was selected and reviewed based on the PICO question. To search for the evidences a proper search strategy was formulated by setting up inclusion and exclusion criteria. The first step of the search strategy is the development of search terms or key phrases. The terms that were formulated in this context were ‘Supraventricular tachycardia’, ‘SVT’, ‘Adenosine’, and ‘Verapamil’. The phrases were entered into the databases like PUBMED, CINAHL, NCBI, and Cochrane library. The inclusion criteria which were established in this context were that the selected evidence must be published in English and within the period of 2011-2021. All other articles, where the language is not English and published before 2011 were excluded for the literature review. The selected articles are presented in a tabular form below:

It is a qualitative research study, where the literature review is done and based on the literature selected the analysis will also be done. The research question for this study was: “What is the effectiveness of Adenosine in treating Supraventricular tachycardia in comparison with Verapamil?” All the research articles were selected on the basis of the research question formulated. The ethical consideration that was made during the evidenced-based-research is that the review and selection of all the research were done on the basis of the fact that all the researches were done by following the ethical principles and after obtaining the informed consent from the participants. The researchers must prioritize the participants’ opinions, respect their willingness, and provide them with the option to withdraw from the study at any time. Furthermore, the researchers must seek informed consent from the respondents before include them in the study. The researchers must also make sure that all of the participants are at ease, since this will help them acquire the respect of the participants. Furthermore, it is critical for researchers to mention any potential health risks associated with their research.  To maintain privacy, the data will be saved using security and a password in the system (Petrova, Dewing & Camilleri, 2016). Another crucial aspect of research ethics is ensuring the confidentiality of the patient’s data, as violating privacy could severely harm the researchers’ reputation.

The theoretical model that can be incorporated in this content is thematic analysis. From the included evidences it can be clearly seen that the themes (opinions or findings of the studies) supported the use of adenosine over verapamil among patients with supraventricular tachycardia. The themes mainly focused on the studies were mechanism action of the drugs on the patients as well as the adverse events that caused due to the usage of two medications. Hence, in this context, theoretical framework will be presented by describing the mechanism of action and adverse effects of two listed medications and their effect on the patients.

Literature Review

  The medication used in the intervention is the adenosine which is often used in supraventricular tachycardia (SVT), because of the antiarrhythmic properties (Singh & McKintosh, 2021). This medication significantly reduces the conduction time via the A-V node, along with interrupt the pathways of reentry via A-V node as well as can restore the sinus rhythm into normal among paroxysmal supraventricular tachycardia (PSVT) patients, which also incorporated PSVT associated with Wolff-Parkinson-White Syndrome (Singh & McKintosh, 2021). From the aspect of side effects, it has been found that Adenosine’s vasodilatory qualities are responsible for the majority of its adverse effects. Vasodilation can cause flushing and headaches, which are also symptoms of vasodilation. Adenosine can cause fast arterial hypotension, which is restored immediately after the adenosine infusion is stopped (Singh & McKintosh, 2021). Although there is no clinical data to support this harmful impact, coronary vascular steal is a theoretical worry in some people with coronary artery disease.

Verapamil, on the other hand, belongs to the calcium-channel blocker drug class. It functions by relaxing blood arteries, allowing the heart to pump more efficiently. Verapamil is a calcium channel blocker that isn’t dihydropyridine. Throughout depolarization, Verapamil or calcium channel blockers prevent ca2+ from entering the sluggish L-type calcium channels in the vascular smooth muscle and heart (Fahie & Cassagnol, 2021). This inhibition causes relaxation of myocardial vascular smooth muscle as well as coronary vasodilation, which would be beneficial in hypertensive patients. Verapamil also improves individuals with vasospastic angina by increasing myocardial oxygen supply. Verapamil is linked to a reduction in sympathetic stimulation or activation and unfavorable chronotropic effects (Fahie & Cassagnol, 2021). The side effects of Verapamil, which are abundantly reported incorporate sinus bradycardia, severe hypotension as well as pulmonary oedema (Rosendorff et al., 2015). This might also cause second-degree atrioventricular block. As it causes severe hypotension, hence it is not prescribed to every patient and Adenosine is prescribed over this medication.

From the analysis, it can be proposed that among two medications adenosine is better than verapamil and hence, it can be prescribed to elderly patients. The evidences stated that, adenosine has greater incidence of minor side effects while other medication verapamil has a greater rate of resulting in hypotension (Alabed et al., 2017).  However, a selection between the two drugs must be decided on a case-by-case basis, preferably with informed consultation with the patient. The proposed solution, i.e., prescribing adenosine need to be informed to the stakeholders. Multiple stakeholders, comprising society as a whole, patients, clinicians (especially nurses and doctors), researchers, executives, and educators, are responsible for ensuring that patient care is administered safely and that patients are not mistreated (Vahdat et al., 2014). Moreover, proper education of the stakeholders also needs to be done as appropriate education of medication administration and dosage could help to promote the right treatment of SVT and promotes patient-centered care. Another benefit of educating the stakeholders is that it makes sure the care continuity as well as decreases the complications of diseases (SVT).

Implementation is a goal-oriented process that involves a series of decisions, actions, and adjustments to ensure that beneficial innovations are fully utilized in educational contexts. In this case, the investigation stage of implementation is required since a new programme or technique must be implemented. The aim of this process is to establish whether a potential innovation or strategy meets the needs of the community and whether it can be executed (activeimplementation.org, 2021). A team of implementation monitors and evaluates the possible fit between community needs, new practice or innovation requirements, as well as community resources during Exploration. Communication with practitioners, executives, as well as other staff members, family members and community stakeholders, distributors and “experts,” and other implementing sites and local bodies are all part of this process. After completing this exploration stage, the team make a decision to proceed or not to proceed. An implementation team is a well-organized and engaged group that uses implementation phases to support the implementation, viability, and scale-up of useful innovations (activeimplementation.org, 2021). A crucial early step in the sustainability process is to form a team to drive the implementation process. If an implementation team is not available, the exploration stage is when a team should be formed and put into action. The implementation team should be made up of people who have the requisite knowledge to execute the new programme as well as to build and manage the systems and infrastructures that will support it.

Evidence and Findings

In this context, the implementation can be done by using a teaching module. A module is a collection of learning opportunities related to a single topic that includes explicit objectives, activities of teaching–learning, and assessment activities. Modular education takes a different approach to learning and improves learning results. Teaching modules for the practitioners as well as the patients, in this study would contain the information about adenosine and details of proper usage. Organization administrators or medical representative might act as the promoter of this medicine as a part of the teaching module. Medical representatives are in charge of providing information about medical items to doctors and other medical staff so that consumers can receive the finest medicine for their condition treatment. Physicians and medical professionals can have a significant impact on how a medication from a certain business is perceived (Ing-udomnoogoon, 2019). Healthcare professionals also need to educate their physicians, who need to find the best way to evaluate the use of adenosine over verapamil.

Evaluators seek for processes inside programmes that cause impacts in the realm of evaluation. Generating a decision and, in many cases, verifying a hypothesis of explanation of a theory are both part of the assessment process. Evaluation is the process of examining a programme, action, intervention, or initiative to see how well it achieves its goals (cdc.gov, 2021). Evaluations can help determine what works well and what should be altered in a programme or initiative. An evaluation plan outlines the evaluation’s focus (such as an exercise, treatment, programme, or strategic plan), the assessment concept, evaluation research questions, data collection technique, evaluation events, stakeholders who should be involved, timeframe, performance standards, specific actions, and costs. Create an evaluation plan before the programme begins to ensure that the evaluation study questions, measurements, and procedures are aligned with the evaluation’s goals (cdc.gov, 2021). This is possible that the assessment strategy for determining the impact of adenosine on participants’ health outcomes, behaviours, and knowledge is experimental. This type of evaluation is done to determine whether a programme or intervention is more effective than the current way. It requires randomly assigning people to either a treatment or a control group. This type of design is sometimes commonly regarded as a benchmark against which most other research designs are judged since it provides a powerful technique for evaluating cause and effect (cdc.gov, 2021). In rural community health programme evaluation research, fully experimental methods are unusual, although they are conceivable.

In this context, the evaluation plan could be measured by establishing two outcomes such as measuring the effects of adenosine among the elderly patients and the second one would be sales of Adenosine in treatment of SVT. From the literature selected it was already evident that Adenosine is particularly useful for the detection of tachycardia and for the acute treatment of PSVT involving atrioventricular nodes of all ages, without the risk of cardiac arrest and hypotension associated with verapamil (Holdgate & Foo, 2012). However, the evaluation outcomes or variables would be fewer side effects, significantly lower risk of cardiac arrest and very lower rate of hypotension. Another evaluative strategy would be selling rate of the medication over other similar type of drug which help the evaluators to understand the effectiveness, popularity and demand of the medicine.

Disseminating research results successfully, necessitates meticulous preparation, evaluation, targeting, and communication with target audiences (Rickinson, 2017). There is a considerable difference between writing down research findings and paying careful attention to someone else. It really is critical to find out or evaluate how the target audience may be reached when distributing a study’s findings, based on who the researcher wants to reach. It is vital to provide certain data points from important discoveries in order to disseminate the findings. To effectively disseminate the research finding as well as the adenosine effectiveness, the stakeholders can be educated by using power point presentation (PPT) which will help them to understand about the targeted medication. According to ncsl.org (2021), a PowerPoint slide presentation can be used to accompany a lecture, depict a difficult idea, or discuss research findings with a big group of people. With the rise of web-based meetings as well as seminars, PowerPoint presentations have become more popular. A slide presentation’s objective is to offer visual support for the material being presented. The narrative is not contained in the PowerPoint slides, and they cannot successfully stand alone. In this context, the power point presentation would contain the dosage, and mechanism of action of Adenosine, adverse effects and other associate facts such as comparison with Verapamil in treatment of paroxysmal supraventricular tachycardia (PSVT).

Conclusion

Supraventricular tachycardia is one type of cardiac disorder where the heart beat is very irregular and quick. The patients of SVT often experience an abnormally erratic or rapid heartbeat in the upper chambers of the heart. In this context, two medications were focused where the first medication is Adenosine, that injected as intravenous (IV) bolus and yields transient atrioventricular nodal block. The significant portion of paroxysmal supraventricular tachycardias, that include the atrioventricular node within every re-entrant circuit, can be converted to sinus rhythm with this. Verapamil, on the other hand, is still the most commonly recommended calcium antagonist for the management of cardiac arrhythmias. This is the most effective and powerful medication for paroxysmal supraventricular tachycardia, especially circus motion tachycardia both with and without pre-excitation. The literature review suggested that From the aspect of side effects, it has been found that Adenosine’s vasodilatory qualities are responsible for the majority of its adverse effects and Adenosine can cause fast arterial hypotension, which is restored immediately after the adenosine infusion is stopped. Verapamil, on the other hand, incorporate sinus bradycardia, severe hypotension as well as pulmonary oedema as adverse effects. As it causes severe hypotension, hence it is not prescribed to every patient and Adenosine is prescribed over this medication. The findings and proposed solution could be implemented by developing and using a teaching module. Healthcare professionals need to educate their physicians, who need to find the best way to evaluate the use of adenosine over verapamil. The evaluation plan illustrated that it could be measured by establishing two outcomes such as measuring the effects of adenosine among the elderly patients and the second one would be sales of Adenosine in treatment of SVT. The dissemination could be done by educating the stakeholders by using the power point presentation, which would contain the dosage, and mechanism of action of Adenosine, adverse effects and other associate facts such as comparison with Verapamil.

Reference

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