What is the treatment for Supraventricular Tachycardia (SVT)?

From the Guidelines

Treatment for Supraventricular Tachycardia (SVT)

The initial treatment for SVT should be attempting vagal maneuvers, such as the Valsalva maneuver or carotid massage, to try to convert the rhythm back to normal 1.

• These maneuvers are recommended as the first-line intervention to terminate SVT and should be performed with the patient in the supine position.
• If vagal maneuvers are unsuccessful, pharmacological conversion using adenosine is recommended, starting with a dose of 6 mg intravenously, which can be repeated at 2-minute intervals up to a maximum dose of 12 mg if necessary 1.
• Adenosine is effective for conversion of orthodromic AVRT in 90% to 95% of patients, with minor and brief side effects occurring in approximately 30% of patients 1.
• If adenosine is ineffective or contraindicated, alternative medications such as calcium channel blockers (e.g., verapamil 2.5-5 mg intravenously) or beta blockers (e.g., metoprolol 2.5-5 mg intravenously) can be considered 1.
• In cases of hemodynamic instability, electrical cardioversion with a synchronized shock is recommended 1.
• Long-term management may involve the use of medications such as flecainide or propafenone to prevent recurrence, and in some cases, catheter ablation may be considered for definitive treatment 1.
• Patients with SVT should be educated on how to perform vagal maneuvers for ongoing management of SVT 1.

From the FDA Drug Label

Verapamil inhibits the calcium ion (and possibly sodium ion) influx through slow channels into conductile and contractile myocardial cells and vascular smooth muscle cells. The antiarrhythmic effect of verapamil appears to be due to its effect on the slow channel in cells of the cardiac conduction system... By interrupting reentry at the AV node, verapamil can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardias (PSVT), including PSVT associated with Wolff-Parkinson-White syndrome.

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 treatment for Supraventricular Tachycardia (SVT) includes:

• Verapamil (IV): can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardias (PSVT) by interrupting reentry at the AV node 2
• Flecainide (PO): is indicated for the prevention of paroxysmal supraventricular tachycardias (PSVT) in patients without structural heart disease 3

From the Research

Treatment Options for Supraventricular Tachycardia (SVT)

The treatment for SVT depends on the patient's condition and can include:

• Vagal maneuvers, such as the Valsalva maneuver, carotid massage, and ice to the face, which can help terminate the tachycardia 4, 5, 6, 7, 8
• Medical therapy, such as adenosine, beta-blockers, and antiarrhythmic agents, which can help convert the arrhythmia to a normal sinus rhythm 5, 7
• Electrical cardioversion, which is recommended for patients who are hemodynamically unstable 4, 5, 7
• Catheter ablation, which is a safe and highly effective treatment option for preventing recurrence of PSVT 5

Vagal Maneuvers

Vagal maneuvers are recommended as the first-line treatment for SVT and can include:

• Modified Valsalva maneuver (MVM), which has been shown to be the most effective vagal maneuver for terminating SVT 6, 8
• Standard Valsalva maneuver (sVM), which has a lower success rate compared to MVM 6, 8
• Carotid sinus massage (CSM), which has the lowest success rate among the three vagal maneuvers 6, 8

Pharmacological Management

Pharmacological management of SVT can include:

• Adenosine, which is highly effective in converting SVT to a normal sinus rhythm 5
• Beta-blockers, which can help control the heart rate and prevent recurrence of SVT 5, 7
• Antiarrhythmic agents, which can help prevent recurrence of SVT 5
• Calcium channel blockers, which can help control the heart rate and prevent recurrence of SVT 5