From the Guidelines
The treatment for supraventricular tachycardia (SVT) should start with vagal maneuvers, such as the Valsalva maneuver or carotid sinus massage, and if these fail, adenosine is the first-line medication, as recommended by the most recent guidelines 1. The initial approach to managing SVT involves attempting to terminate the arrhythmia using vagal maneuvers, which can be quickly performed and are recommended as the first-line intervention 1.
- Vagal maneuvers include the Valsalva maneuver, carotid sinus massage, and the diving reflex, with the Valsalva maneuver being more successful than carotid sinus massage in one study involving 148 patients with SVT 1.
- If vagal maneuvers are unsuccessful, adenosine is beneficial for acute treatment in patients with orthodromic AVRT, with a success rate of 90% to 95% and minor side effects occurring in approximately 30% of patients 1.
- For hemodynamically unstable patients with AVRT, synchronized cardioversion should be performed if vagal maneuvers or adenosine are ineffective or not feasible, as it is highly effective in terminating AVRT and avoids complications associated with antiarrhythmic drug therapy 1.
- The use of other medications such as ibutilide, procainamide, and amiodarone may be considered in specific situations, such as pre-excited AF or in patients who are hemodynamically stable, but their use is guided by more recent recommendations that have downgraded or no longer recommend certain antiarrhythmic drugs for various types of tachycardias 1.
- Long-term management of SVT may include oral medications and addressing underlying causes, with catheter ablation being considered for recurrent episodes as it can provide a definitive cure by targeting the abnormal electrical pathways causing the arrhythmia.
- The most recent guidelines from 2020 provide updated recommendations on the use of adenosine, beta-blockers, and other antiarrhythmic drugs for the management of SVT, emphasizing the importance of selecting the appropriate treatment based on the specific type of tachycardia, patient stability, and underlying conditions 1.
From the Research
Treatment for Supraventricular Tachycardia (SVT)
- The treatment for SVT may involve the use of calcium channel blockers, as they have been shown to be effective in converting SVT to sinus rhythm 2.
- Beta blockers are also often used as a first line of treatment for SVT, and have been established as a effective treatment option 3.
- Adenosine may also be used to treat SVT, although it was not found to be as effective as calcium channel blockers in one study 2.
- The choice of treatment for SVT depends on the individual patient's condition and medical history, and may involve a combination of medications and other therapies.
Anti-Arrhythmic Agents
- Anti-arrhythmic agents, such as class Ic drugs, may be used to treat SVT, but should be used with caution due to the risk of proarrhythmia 4.
- Class III agents, such as amiodarone, may also be used to treat SVT, but should be used with caution due to their potential side effects 4.
- Calcium-channel blockers, which are classified as class IV anti-arrhythmic agents, may be used to treat SVT, and have been shown to be effective in converting SVT to sinus rhythm 2, 4.
Management of SVT
- The management of SVT should involve a stepwise approach, including diagnosis, differentiation from ventricular tachycardia, and treatment 5.
- The treatment of SVT should be individualized based on the patient's condition and medical history, and may involve a combination of medications and other therapies 3, 5.