From the Guidelines
Supraventricular tachycardia (SVT) is commonly triggered by caffeine, alcohol, stress, fatigue, smoking, and certain medications like decongestants and stimulants, and the most effective treatment option is vagal maneuvers as first-line intervention, such as the Valsalva maneuver or carotid sinus massage, as recommended by the 2015 ACC/AHA/HRS guideline 1.
Triggers of SVT
- Caffeine
- Alcohol
- Stress
- Fatigue
- Smoking
- Certain medications like decongestants and stimulants
Treatment Options for SVT
- Vagal maneuvers, such as the Valsalva maneuver or carotid sinus massage, which can help slow the heart rate by increasing parasympathetic tone 1
- Adenosine (6-12mg IV push), which blocks AV node conduction temporarily 1
- Beta-blockers like metoprolol (5mg IV) 1
- Calcium channel blockers such as diltiazem (0.25mg/kg IV over 2 minutes) 1
- Catheter ablation, which offers a definitive treatment with 90-95% success rates for most SVT types by destroying the abnormal electrical pathway 1
Long-term Management of SVT
- Daily medications may include beta-blockers (metoprolol 25-100mg twice daily) 1
- Calcium channel blockers (diltiazem 120-360mg daily) 1
- Antiarrhythmics like flecainide (50-200mg twice daily) 1
- Patients should avoid known triggers, stay hydrated, limit stimulants, manage stress, and learn to perform vagal maneuvers at home 1
Importance of Shared Decision Making
- Patients should be included in clinical decision-making processes, with consideration of their preferences and goals for therapy, as well as their unique physical, psychological, and social situation 1
- Shared decision making is especially important for patients with SVT, as treatment options can be nuanced and require expert knowledge of EP processes and treatment options 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 •paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms
The triggers for Supraventricular Tachycardia (SVT) are not explicitly stated in the provided drug labels. The treatment options for SVT include flecainide acetate tablets, USP, which are indicated for the prevention of paroxysmal supraventricular tachycardias (PSVT) in patients without structural heart disease 2. Another treatment option is propafenone, which reduced the rate of both paroxysmal atrial fibrillation/flutter (PAF) and paroxysmal supraventricular tachycardia (PSVT) in clinical trials 3. Key points to consider when treating SVT include:
- Flecainide acetate tablets, USP should be used with caution due to the risk of proarrhythmic effects 2 2.
- Propafenone may be effective in reducing the rate of SVT episodes, but long-term safety data is limited 3.
From the Research
Triggers of Supraventricular Tachycardia (SVT)
- Caffeine ingestion can trigger SVT or reduce the effectiveness of adenosine in treating SVT, as shown in a study where recent caffeine ingestion reduced adenosine efficacy in the treatment of paroxysmal supraventricular tachycardia 4
- Other potential triggers may include stress, certain medications, and underlying heart conditions, although these are not directly mentioned in the provided studies
Treatment Options for SVT
- Adenosine is a common treatment for SVT, but its effectiveness can be reduced by recent caffeine ingestion 4
- Calcium channel blockers, such as verapamil and diltiazem, can be used to treat SVT, either as a slow infusion or as an alternative to adenosine 5, 6
- The efficacy and safety of slow infusions of calcium channel blockers have been demonstrated in several studies, with high conversion rates and low risk of hypotension 5, 6
- Other antiarrhythmic agents, such as propafenone, sotalol, and amiodarone, may also be used to treat SVT, although their usage and efficacy vary by region and patient population 7
- Catheter ablation is not typically used as a first-line treatment for SVT, but may be considered for patients with ventricular tachycardia or other underlying heart conditions 8