What are the medications used to treat Supraventricular Tachycardia (SVT)?

From the Guidelines

For the management of supraventricular tachycardia (SVT), oral beta blockers, diltiazem, or verapamil are recommended for ongoing management in patients with symptomatic SVT who do not have ventricular pre-excitation during sinus rhythm. The choice of medication depends on the specific type of SVT, patient comorbidities, and side effect profiles.

• For acute termination of SVT, adenosine is the first-line medication, typically given as a rapid IV push starting at 6 mg, followed by 12 mg if needed 1.
• Calcium channel blockers like verapamil (5-10 mg IV) or diltiazem (0.25 mg/kg IV) are effective alternatives for acute termination of SVT 1.
• Beta-blockers such as metoprolol (5 mg IV) can also terminate acute episodes of SVT 1.
• For long-term prevention, oral medications include beta-blockers (metoprolol 25-100 mg twice daily), calcium channel blockers (diltiazem 120-360 mg daily or verapamil 120-480 mg daily), and antiarrhythmics like flecainide (50-200 mg twice daily) or propafenone (150-300 mg three times daily) 1.
• Patients should be aware that some medications may cause fatigue, hypotension, or bradycardia and should report significant side effects to their healthcare provider.
• The most recent guidelines from the European Heart Journal recommend adenosine as the drug of choice for the acute therapy of SVT when vagal maneuvers fail, and also recommend ivabradine, alone or in combination with beta-blockers, in symptomatic patients with inappropriate sinus tachycardia and postural orthostatic tachycardia syndrome 1.

From the FDA Drug Label

For patients with PSVT and patients with PAF the recommended starting dose is 50 mg every 12 hours. Flecainide doses may be increased in increments of 50 mg bid every four days until efficacy is achieved In patients without structural heart disease, flecainide acetate tablets, USP are indicated for the prevention of: •paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia and other supraventricular tachycardias of unspecified mechanism associated with disabling symptoms •paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms

The medication flecainide is used to treat supraventricular tachycardia (SVT), including:

• Paroxysmal supraventricular tachycardias (PSVT)
• Paroxysmal atrial fibrillation/flutter (PAF) The recommended starting dose for PSVT and PAF is 50 mg every 12 hours 2. Key points:
• The dose may be increased in increments of 50 mg bid every four days until efficacy is achieved
• The maximum recommended dose for patients with paroxysmal supraventricular arrhythmias is 300 mg/day 2

From the Research

SVT Medications

• The following medications are used to treat Supraventricular Tachycardia (SVT):
  • Adenosine: a first-line therapy for acute diagnosis and management of SVT 3, 4
  • Beta-blockers: an alternative therapy for SVT 3, 4
  • Calcium channel blockers: an alternative therapy for SVT, including verapamil and diltiazem 3, 4, 5, 6
  • Digoxin: may be useful in patients with significant heart failure 4

Comparison of Adenosine and Calcium Channel Blockers

• A study comparing adenosine and calcium channel blockers found that calcium channel blockers had a higher conversion rate (98% vs 86.5%) 5
• Another study found no differences in the number of people reverting to sinus rhythm who were treated with adenosine or calcium channel blockers (89.7% vs 92.9%) 6
• Calcium channel blockers are considered a safe and affordable alternative to adenosine in the emergency treatment of stable patients with SVT 5

Side Effects and Safety

• Adenosine and calcium channel blockers have significant side effect profiles 6
• Hypotension is a potential side effect of calcium channel blockers, but the incidence is low (0.66% vs 0%) 5, 6
• Adenosine is generally considered safe, but can cause minor adverse effects such as flushing and dyspnea 6