Objective:

To evaluate weight-based adenosine dosing and cardioversion success in pediatric patients with supraventricular tachycardia (SVT) across different electrophysiologic classifications.

Approach:

• Systematic Review and Meta-Analysis: Conducted in accordance with Cochrane Handbook and PRISMA guidelines, focusing on studies involving patients under 18 years with SVT, reporting intravenous adenosine dosing and bolus-level cardioversion outcomes.
• Eligibility Criteria: Included studies with patients <18 years, weight-based adenosine dosing, and clear administration protocols; excluded studies involving adults or lacking dose-specific outcomes.
• Data Extraction: Systematic search of multiple databases for relevant studies, with data on demographics, dosing, and cardioversion outcomes extracted by independent reviewers.
• Endpoints and Subgroup Analyses: Main outcome was successful cardioversion to sinus rhythm; subgroup analyses were performed based on weight-based dosing categories and electrophysiologic classifications.
• Quality Assessment: Risk of bias assessed using the ROBINS-I tool and certainty of evidence evaluated using the GRADE framework.
• Statistical Analysis: Used a three-level random-effects model for quantitative synthesis of cardioversion outcomes, accounting for multiple bolus administrations within studies.

Key Findings:

• The analysis revealed a significant correlation between weight-based dosing of adenosine and the success rate of cardioversion in pediatric patients with SVT.
• Variations in electrophysiologic classifications were noted to influence the efficacy of adenosine administration, suggesting that tailored dosing strategies may enhance outcomes.
• The review highlighted the importance of standardized protocols for adenosine administration to optimize cardioversion success rates in this population.

Interpretation:

The findings suggest that weight-based adenosine dosing is critical for achieving successful cardioversion in pediatric SVT patients. The influence of electrophysiologic classifications on treatment efficacy indicates that individualized treatment approaches may be necessary. This underscores the importance of further research to refine dosing strategies and improve clinical outcomes.

Limitations:

• Small number of studies included in the analysis.
• Potential variability in study methodologies and patient populations.
• Limited generalizability due to the heterogeneity of included studies and differences in clinical practices.

Conclusion:

The findings underscore the need for further research to establish optimal adenosine dosing protocols and to evaluate the long-term outcomes of cardioversion in pediatric SVT patients. Future studies should aim to standardize treatment approaches and explore the impact of different electrophysiologic classifications on treatment efficacy to enhance clinical practice in this area.