From the Guidelines
The most effective treatment for Supraventricular Tachycardia (SVT) is to start with vagal maneuvers, followed by intravenous adenosine if necessary, as recommended by the latest guidelines 1.
Treatment Approach
The treatment approach for SVT involves several steps:
- Vagal maneuvers, such as the Valsalva maneuver or carotid sinus massage, are the first line of treatment to slow the heart rate.
- If vagal maneuvers are unsuccessful, intravenous adenosine is the next step, typically given as a 6 mg rapid bolus followed by a 12 mg dose if needed.
- For ongoing management, beta-blockers such as metoprolol (5 mg IV) can be effective, as their strength of recommendation has been increased in the latest guidelines 1.
Management of Specific Cases
- In hemodynamically unstable patients, synchronized cardioversion at 50-100 joules is recommended.
- For long-term management, catheter ablation offers a definitive cure with success rates exceeding 95% for most SVT types.
- Alternatively, daily medications like beta-blockers (metoprolol 25-100 mg twice daily) can prevent recurrences.
Important Considerations
- The latest guidelines have downgraded the use of verapamil and diltiazem in acute management of narrow-QRS tachycardias, and no longer recommend amiodarone and digoxin for acute management of narrow-QRS tachycardias 1.
- Patients should be educated about recognizing symptoms and performing vagal maneuvers at home before seeking emergency care for persistent episodes.
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 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.
Treatment for SVT can include:
- Flecainide acetate tablets, USP, for the prevention of paroxysmal supraventricular tachycardias (PSVT) in patients without structural heart disease 2
- Verapamil hydrochloride, which can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardias (PSVT) by interrupting reentry at the AV node 3
From the Research
Treatment Options for SVT
- Hemodynamically unstable patients with SVT should be treated with electrical cardioversion 4
- For stable patients, acute termination of tachycardia can be achieved by vagal maneuvers or medical therapy 4
- Vagal maneuvers include the Valsalva maneuver, carotid massage, and ice to the face 4
Vagal Maneuvers
- The Valsalva maneuver is a common vagal maneuver used to treat SVT 5, 6, 7, 8
- A modified Valsalva maneuver has been shown to be effective in terminating SVT, with a success rate of 43% 5, 6
- The reverse Valsalva maneuver is a new technique that has shown promising results, with a success rate of 91% in a small case series 7
- Carotid sinus massage is another vagal maneuver that can be used to treat SVT, with a success rate of 10.5% to 14% 8
Medical Therapy
- Adenosine is a common medical therapy used to treat SVT, with a success rate of 91% 6
- Other medical therapies, such as calcium channel blockers, β-blockers, and antiarrhythmic agents, can also be used to manage SVT 6