From the Guidelines
Metoprolol is effective for managing supraventricular tachycardia (SVT) by slowing conduction through the AV node, and its use is supported by the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1. For acute SVT, intravenous metoprolol can be administered at 2.5–5.0-mg IV bolus over 2 min, which may be repeated twice at 5-minute intervals for a maximum dose of 15 mg, as recommended in the 2015 ACC/AHA/HRS guideline 1. Some key points to consider when using metoprolol for SVT include:
- Metoprolol works by blocking beta-1 adrenergic receptors in the heart, reducing sympathetic stimulation, slowing heart rate, and decreasing AV nodal conduction.
- This makes it particularly useful for SVT mechanisms involving the AV node, such as AV nodal reentrant tachycardia (AVNRT) or atrioventricular reentrant tachycardia (AVRT).
- Patients should be monitored for potential side effects including bradycardia, hypotension, bronchospasm, and fatigue.
- Metoprolol should be used cautiously in patients with asthma, COPD, heart failure, diabetes, or significant bradycardia, and may not be the first-line treatment for all SVT types, particularly those not involving the AV node. The most recent and highest quality study, the 2015 ACC/AHA/HRS guideline, provides the best evidence for the use of metoprolol in SVT, and its recommendations should be followed in clinical practice 1.
From the Research
Metoprolol in SVT
- Metoprolol is a beta blocker that can be used in the management of supraventricular tachycardia (SVT) 2, 3, 4.
- It can be used acutely or as long-term therapy for SVT 2.
- Beta blockers, including metoprolol, are effective in controlling the ventricular rate in patients with SVT 5, 6.
- However, beta blockers may not be as effective as adenosine or calcium channel blockers in converting SVT to sinus rhythm 6.
- Metoprolol can be used in patients with SVT who are hemodynamically stable, but it is not the first-line treatment for patients with hemodynamic instability 5, 6.
Comparison with Other Treatments
- Adenosine is often the first-line treatment for SVT, but metoprolol can be used as an alternative 2, 3, 4.
- Calcium channel blockers, such as verapamil and diltiazem, are also effective in treating SVT and may be used as an alternative to metoprolol 2, 6.
- The choice of treatment for SVT depends on the patient's symptoms, medical history, and preferences 3, 4.
Special Considerations
- Metoprolol can be used in patients with SVT who have certain medical conditions, such as hypertension or heart failure 4.
- However, metoprolol may not be suitable for patients with certain medical conditions, such as asthma or chronic obstructive pulmonary disease (COPD) 4.
- The dosage of metoprolol may need to be adjusted in patients with renal or hepatic impairment 4.