What is the treatment for Supraventricular Tachycardia (SVT)?

From the Guidelines

For acute supraventricular tachycardia (SVT) treatment, vagal maneuvers such as the Valsalva maneuver or carotid sinus massage should be attempted first, as they can effectively terminate the episode by increasing parasympathetic tone, as recommended by the 2015 ACC/AHA/HRS guideline 1. If these maneuvers fail, intravenous adenosine is the next line of treatment, typically administered as a 6mg rapid bolus, followed by a 12mg dose if needed, due to its effectiveness in converting SVT to sinus rhythm, as supported by the guideline 1. For hemodynamically unstable patients, immediate synchronized cardioversion at 50-100 joules is recommended, as it is highly effective in restoring sinus rhythm and preventing potential complications, as stated in the guideline 1. In terms of long-term management, options include beta-blockers, calcium channel blockers, or antiarrhythmics like flecainide, with catheter ablation offering a definitive treatment with high success rates for most SVT types, as discussed in the guideline 1. Some key points to consider in the management of SVT include:

• The importance of patient education on performing vagal maneuvers for ongoing management of SVT, as they can help terminate episodes and reduce the need for medical attention, as recommended by the guideline 1.
• The role of electrophysiological study with the option of ablation in the diagnosis and potential treatment of SVT, as it provides a definitive cure without the need for chronic pharmacological therapy, as stated in the guideline 1.
• The consideration of flecainide or propafenone for ongoing management in patients without structural heart disease or ischemic heart disease who have symptomatic SVT and are not candidates for, or prefer not to undergo, catheter ablation, as they have been shown to be effective in preventing recurrences of SVT, as discussed in the guideline 1. Overall, the management of SVT should be tailored to the individual patient's needs and circumstances, taking into account the severity of symptoms, the presence of underlying heart disease, and the patient's preferences and lifestyle, as emphasized in the guideline 1.

From the FDA Drug Label

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

Flecainide acetate is indicated for the prevention of paroxysmal supraventricular tachycardias (PSVT) in patients without structural heart disease.

• The use of flecainide acetate for treatment of sustained VT should be initiated in the hospital 2.
• Flecainide acetate can cause proarrhythmic effects, including new or worsened supraventricular or ventricular arrhythmias 2. Key points to consider when using flecainide acetate for PSVT:
• Dosage: follow the recommended dosage schedule to minimize the risk of proarrhythmic events.
• Monitoring: careful monitoring is required, especially in patients with underlying heart disease.
• Hospital initiation: therapy should be started in the hospital for patients with sustained VT.

From the Research

Treatment Options for Supraventricular Tachycardia (SVT)

• Vagal maneuvers are often used as the first-line treatment for SVT, as they can help terminate the arrhythmia 3, 4, 5
• Adenosine is also commonly used to treat SVT, particularly if vagal maneuvers are unsuccessful 3, 4, 6, 5, 7
• Calcium channel blockers, such as verapamil or diltiazem, can be used as an alternative to adenosine or in combination with it 4, 6, 5, 7
• Beta blockers, such as metoprolol, can also be used to treat SVT, either acutely or as long-term therapy 3, 4, 5
• Catheter ablation is a highly effective treatment for SVT, with a success rate of 95% and a recurrence rate of less than 5% 4, 5

Comparison of Treatment Options

• Adenosine and calcium channel antagonists have similar efficacy in converting SVT to sinus rhythm, with no significant difference in reversion rate or relapse rate 6, 7
• However, adenosine is associated with a higher incidence of minor adverse events, such as nausea and chest tightness, while calcium channel antagonists may cause hypotension 6, 7
• The choice of treatment should be individualized based on patient factors, such as symptoms, medical history, and preferences 3, 4

Long-Term Management

• Long-term management of SVT depends on the frequency and severity of symptoms, as well as the patient's risk profile and preferences 3, 4
• Options for long-term management include conservative management, medication therapy, and catheter ablation 3, 4, 5
• Patients with recurrent or symptomatic SVT should be referred to a cardiologist for further evaluation and treatment 3, 4