What is the management of Supraventricular Tachycardia (SVT)?

From the Guidelines

The most effective management of SVT involves a combination of vagal maneuvers, pharmacological therapy, and catheter ablation, with the choice of treatment depending on the individual patient's symptoms, preferences, and comorbidities. When considering ongoing management of SVT, the guidelines recommend oral beta blockers, diltiazem, or verapamil as useful for patients with symptomatic SVT who do not have ventricular pre-excitation during sinus rhythm 1. Some key points to consider in the management of SVT include:

• Vagal maneuvers, such as the Valsalva maneuver or the application of an ice-cold, wet towel to the face, can be effective in terminating SVT episodes and should be taught to patients as part of their ongoing management 1.
• EP study with the option of ablation is a useful diagnostic and therapeutic tool for SVT, offering the potential for definitive cure without the need for chronic pharmacological therapy 1.
• For patients without structural heart disease or ischemic heart disease, flecainide or propafenone may be reasonable alternatives for ongoing management, although these medications carry a risk of proarrhythmia and should be used with caution 1. The goal of treatment is to reduce the frequency and duration of SVT episodes, improve symptoms, and enhance quality of life, while minimizing the risk of adverse effects and complications. In terms of specific pharmacological therapies, the guidelines suggest that:
• Verapamil, at a dosage of up to 480 mg/day, has been shown to reduce SVT episode frequency and duration in randomized controlled trials 1.
• Beta blockers, such as propranolol, may also be effective in reducing SVT episodes, although the evidence is limited 1. Ultimately, the choice of treatment for SVT will depend on the individual patient's needs and circumstances, and should be guided by a thorough evaluation of the patient's symptoms, medical history, and preferences.

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

The management of Supraventricular Tachycardia (SVT) with flecainide acetate tablets, USP is indicated for the prevention of paroxysmal supraventricular tachycardias (PSVT) in patients without structural heart disease.

• The use of flecainide acetate tablets, USP should be reserved for patients in whom the benefits of treatment outweigh the risks 2.
• It is recommended to follow the recommended dosage schedule to minimize the risk of proarrhythmic events 2.

From the Research

Management of SVT

The management of supraventricular tachycardia (SVT) involves various treatment options, including vagal maneuvers, adenosine, calcium channel antagonists, and catheter ablation.

• Vagal maneuvers are often used as the first-line treatment for SVT, as they are non-invasive and can be effective in terminating the arrhythmia 3.
• Adenosine is also commonly used to treat SVT, particularly if vagal maneuvers are unsuccessful 4, 5.
• Calcium channel antagonists, such as verapamil and diltiazem, can be used as an alternative to adenosine or in combination with it 4, 5.
• Catheter ablation is a highly effective treatment option for SVT, with a success rate of 95% and a recurrence rate of less than 5% 5.

Treatment Options

The choice of treatment for SVT depends on various factors, including the patient's age, clinical status, and underlying heart condition.

• For stable patients, vagal maneuvers and adenosine are often the initial treatment options 6.
• For unstable patients, synchronized cardioversion may be necessary 6.
• For patients with recurrent SVT, long-term treatment options such as beta blockers, calcium channel blockers, and antiarrhythmic medications may be considered 7, 5.
• Catheter ablation is a highly effective treatment option for patients with symptomatic SVT, particularly those with Wolff-Parkinson-White syndrome 5.

Patient Considerations

When managing SVT, it is essential to consider the patient's individual characteristics and needs.

• Patient age and underlying heart condition can influence the choice of treatment 3.
• Patient preference and quality of life should also be taken into account when selecting a treatment option 4.
• Referral to a heart rhythm specialist is recommended for all patients with SVT to determine the best course of treatment 7.