A previously healthy 10-year-old presents with sudden onset palpitations, narrow complex tachycardia at 240 bpm on ECG, no structural heart disease on echo. Vagal manoeuvres failed. Which is the first-line pharmacological treatment?
- A IV amiodarone 5 mg/kg over 20 minutes
- B IV adenosine 0.1 mg/kg rapid IV push (maximum 6 mg first dose) ✓
- C IV verapamil 0.1 mg/kg slowly
- D Synchronised DC cardioversion 0.5 J/kg
Explanation
Supraventricular tachycardia (SVT) in children — the most common arrhythmia requiring treatment — is managed with adenosine as first-line pharmacotherapy after failed vagal manoeuvres. Adenosine 0.1 mg/kg (max 6 mg first dose, may increase to 0.2 mg/kg max 12 mg) is given as a rapid IV push followed by normal saline flush. It terminates re-entry tachycardia via transient AV nodal block. Verapamil is contraindicated in children under 1 year and used cautiously in older children (risk of cardiovascular collapse). Amiodarone is used for refractory/wide-complex tachycardia. DC cardioversion is used for haemodynamically unstable SVT.
Reference: Ghai Essential Pediatrics, 10th ed.
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