Adenosine is recommended as first-line therapy for pediatric supraventricular tachycardia (SVT), but the optimal weight-based dose for reliable first-pass cardioversion remains uncertain. In a study published in Pediatric Cardiology, a systematic review and meta-analysis evaluated the association between weight-based adenosine dosing and cardioversion success in children with SVT. 

The analysis included nine observational studies involving 480 patients and 1,369 intravenous adenosine bolus administrations identified through searches of PubMed, Embase, Scopus, and the Cochrane Library through July 2025.

Findings

• Cardioversion probability increased from 25% (95% CI, 14%–40%) at doses below 100 µg/kg to 59% (95% CI, 48%–69%) at doses between 250 and 400 µg/kg.
• Doses of 100 µg/kg achieved a 38% (95% CI, 31%–46%) conversion probability, while doses between 150 and 225 µg/kg achieved 47% (95% CI, 39%–55%).
• Across all dose categories, the pooled probability of successful cardioversion was 41% (95% CI, 35%–47%).
• Each 100 µg/kg increase in adenosine dose was associated with 72% higher odds of successful cardioversion (OR, 1.72; 95% CI, 1.43–2.07; P<0.001).

The analysis suggested that higher weight-based adenosine doses were consistently associated with greater cardioversion probability in pediatric SVT, whereas lower commonly used starting doses demonstrated modest first-pass conversion rates. Prospective studies may help determine optimal initial dosing strategies in children with SVT.