What is the treatment for Supraventricular Tachycardia (SVT)?

From the Guidelines

Supraventricular tachycardia (SVT) treatment should begin with vagal maneuvers, such as the Valsalva maneuver or carotid sinus massage, to slow the heart rate, as recommended by the 2015 ACC/AHA/HRS guideline 1. The initial approach to treating SVT involves attempting to terminate the arrhythmia using vagal maneuvers, which can be performed quickly and are recommended as the first-line intervention 1.

• Vagal maneuvers, including Valsalva and carotid sinus massage, can be effective in terminating SVT, with a success rate of 27.7% when switching from one technique to the other 1.
• If vagal maneuvers are unsuccessful, intravenous adenosine is recommended as the next step, with a success rate of 90% to 95% in converting orthodromic AVRT 1.
• For patients with hemodynamically unstable SVT, synchronized cardioversion is recommended, as it is highly effective in terminating the arrhythmia and restoring sinus rhythm 1.
• In cases where pharmacological therapy is ineffective or contraindicated, synchronized cardioversion is also recommended for hemodynamically stable patients with SVT 1.
• For long-term management, catheter ablation offers a definitive cure with success rates over 90%, or daily medications like beta-blockers or calcium channel blockers can be used to prevent recurrences 1.
• Patients should be educated on how to perform vagal maneuvers for ongoing management of SVT, as this can help terminate the arrhythmia and reduce the need for medical attention 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 PSVT is not explicitly stated in the label.
• Key points to consider when using flecainide acetate include:
  • The risk of proarrhythmic effects, which can be life-threatening
  • The need for careful dosage titration and monitoring, especially in patients with underlying heart disease
  • The recommendation to initiate therapy in the hospital for patients with sustained ventricular tachycardia 2 2

From the Research

Treatment Options for Supraventricular Tachycardia (SVT)

• Vagal manoeuvres, such as the Valsalva manoeuvre, are commonly used as first-line therapies in the acute diagnosis and management of SVT 3, 4, 5, 6
• Adenosine is also a first-line therapy for the treatment of SVT, with recent studies showing improved outcomes with new techniques in administration 7
• Beta-blockers and calcium channel blockers are alternative therapies for the treatment of SVT 3
• Catheter ablation is a curative treatment option for SVT, with a high success rate in terminating the arrhythmia 3

Efficacy of Vagal Manoeuvres

• The Valsalva manoeuvre has been shown to be effective in terminating SVT, with a success rate of 19.4% to 54.3% in different studies 4, 5
• The modified Valsalva manoeuvre has been shown to be more effective than the standard Valsalva manoeuvre in restoring normal sinus rhythm in adult patients with SVT, with a significantly higher success rate (odds ratio = 4.36; 95% confidence interval, 3.30-5.76; P < 0.001) 6
• Carotid sinus massage is another vagal manoeuvre that can be used to terminate SVT, with a success rate of 10.5% to 14.0% in different studies 4

Management of SVT

• All patients treated for SVT should be referred for a heart rhythm specialist opinion 3
• Long-term treatment of SVT is dependent on several factors, including frequency of symptoms, risk stratification, and patient preference 3
• Management can range from conservative, if symptoms are rare and the patient is low risk, to catheter ablation, which is curative in the majority of patients 3