From the Guidelines
The treatment for supraventricular tachycardia (SVT) should begin with vagal maneuvers, followed by intravenous adenosine as the first-line medication, as recommended by the most recent guidelines 1.
Initial Treatment
The initial approach to treating SVT involves increasing parasympathetic tone through vagal maneuvers such as the Valsalva maneuver or carotid sinus massage. These maneuvers can quickly terminate the episode and are considered the first line of treatment.
Adenosine Therapy
If vagal maneuvers are unsuccessful, intravenous adenosine is the next step, typically given as a 6 mg rapid bolus followed by a saline flush 1. If this initial dose is unsuccessful, a 12 mg dose can be administered, and repeated once if needed. 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.
Alternative Treatments
For persistent SVT, calcium channel blockers like verapamil or diltiazem, or beta-blockers such as metoprolol may be used, although their recommendations have been downgraded in recent guidelines 1. In hemodynamically unstable patients, immediate synchronized cardioversion at 50-100 joules is indicated.
Long-term Management
For long-term management, options include catheter ablation for definitive treatment or maintenance medications such as beta-blockers, although the use of certain antiarrhythmics has been downgraded or is no longer recommended due to potential side effects and the availability of more effective treatments 1.
Key points to consider in the treatment of SVT include:
- Vagal maneuvers as the initial treatment
- Adenosine as the first-line medication for acute treatment
- Consideration of calcium channel blockers or beta-blockers for persistent SVT, with caution due to downgraded recommendations
- Synchronized cardioversion for hemodynamically unstable patients
- Catheter ablation or maintenance medications for long-term management, with careful selection based on the latest guidelines.
From the FDA Drug Label
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. The treatment for supraventricular tachycardia (SVT) is verapamil, which can restore normal sinus rhythm by interrupting reentry at the AV node 2.
- Key points:
- Verapamil is effective in treating paroxysmal supraventricular tachycardias (PSVT)
- It works by interrupting reentry at the AV node
- It can restore normal sinus rhythm in patients with SVT, including those with Wolff-Parkinson-White syndrome
From the Research
Treatment Options for Supraventricular Tachycardia (SVT)
The treatment for SVT can be categorized into acute and long-term management.
- Acute management includes:
- Long-term management includes:
- Calcium channel blockers or beta blockers 3, 4
- Class Ic antiarrhythmics (e.g., flecainide or propafenone) 3
- Class Ia antiarrhythmics (e.g., quinidine, procainamide, or disopyramide), although these are used less often due to their modest effectiveness and adverse effects 3
- Class III antiarrhythmics (e.g., amiodarone, sotalol, or dofetilide), which are effective but have potential adverse effects and should be administered in consultation with a cardiologist 3
- Catheter ablation, which has a high success rate and is the preferred treatment for symptomatic patients with Wolff-Parkinson-White syndrome 3, 4
Comparison of Treatment Options
Studies have compared the effectiveness of different treatment options for SVT.
- Adenosine and verapamil have been shown to be equally effective in converting out-of-hospital SVT to sinus rhythm 7
- Vagal maneuvers have been found to be safe and effective in young, otherwise healthy patients, but may not be suitable for older patients with coronary or cerebrovascular disease 5
- Clinical decision analysis suggests that young patients should be treated initially with vagal maneuvers, while older patients should be treated initially with verapamil 5
Considerations for Treatment
When selecting a treatment option for SVT, several factors should be considered, including: