From the Guidelines
The primary treatment for supraventricular tachycardia (SVT) in the emergency department is vagal maneuvers, followed by adenosine if necessary, as recommended by the most recent guidelines 1. Here's a step-by-step approach:
- Start with vagal maneuvers:
- Have the patient perform a Valsalva maneuver
- If unsuccessful, try carotid sinus massage (if no contraindications)
- If vagal maneuvers fail, administer adenosine:
- Initial dose: 6 mg rapid IV push, followed by a saline flush
- If ineffective, give 12 mg IV push after 1-2 minutes
- Can repeat 12 mg dose once more if needed
- If adenosine fails or is contraindicated, consider:
- Diltiazem: 15-20 mg IV over 2 minutes; can repeat with 20-25 mg after 15 minutes if needed
- Verapamil: 5-10 mg IV over 2 minutes; can repeat with 5-10 mg after 15-30 minutes if needed
- For unstable patients or if other methods fail, perform synchronized cardioversion:
- Start at 50-100 J, increasing as needed
- After conversion, monitor the patient and obtain an ECG Adenosine works by temporarily blocking AV node conduction, often terminating the SVT, as supported by studies 1. Calcium channel blockers like diltiazem and verapamil slow AV node conduction and can terminate or control the rate of SVT. Always ensure proper equipment for potential cardioversion is available, and be prepared to manage potential side effects or complications of medications used. It's also important to note that the European Society of Cardiology guidelines from 2020 1 have updated recommendations for the management of SVT, including the use of adenosine and other antiarrhythmic drugs.
From the FDA Drug Label
Adenosine injection is indicated for the treatment of supraventricular tachycardia (SVT) [is not mentioned in the provided text]
The FDA drug label does not answer the question.
From the Research
Treatment Options for Supraventricular Tachycardia (SVT) in the Emergency Department (ED)
The treatment for SVT in the ED depends on the patient's clinical status. The following are some of the treatment options:
- Vagal maneuvers: This is the first-line treatment for stable patients with SVT 2.
- Adenosine: This is also a first-line treatment for stable patients with SVT, and it is effective in terminating the arrhythmia in most cases 3, 4, 5, 6.
- Synchronized cardioversion: This is the treatment of choice for unstable patients with SVT 3.
- Modified Valsalva maneuver: This is a variation of the traditional Valsalva maneuver that has been shown to be effective in treating SVT 2.
- High-dose adenosine: This may be considered for patients who do not respond to standard doses of adenosine 4.
Special Considerations
- Children with SVT: The clinical presentation of SVT in children can vary with age, and it can be difficult to diagnose in infants and young children. Vagal maneuvers and adenosine are effective treatments for SVT in children, but children with Wolff-Parkinson-White syndrome are at risk of sudden cardiac death and should not be treated with calcium channel blockers or digoxin 6.
- Paramedic-delivered treatment: Trained paramedics can effectively and safely treat SVT with adenosine, and this approach can reduce healthcare costs without compromising patient care 5.