From the Guidelines
Paroxysmal supraventricular tachycardia (PSVT) treatment begins with vagal maneuvers like the Valsalva maneuver or carotid sinus massage to slow the heart rate, as recommended by the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1.
Initial Management
If vagal maneuvers fail, intravenous adenosine is the first-line medication, typically given as a 6 mg rapid bolus followed by a 12 mg dose if needed, as supported by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Recurrent Episodes
For patients with recurrent episodes, calcium channel blockers like verapamil (5-10 mg IV) or diltiazem (0.25 mg/kg IV), or beta-blockers such as metoprolol (5 mg IV) may be used, as suggested by the 2015 ACC/AHA/HRS guideline 1.
Emergency Situations
In emergency situations with hemodynamic instability, synchronized cardioversion at 50-100 joules is recommended.
Long-term Management
For long-term management, catheter ablation offers definitive treatment with success rates exceeding 95% for most PSVT types, as reported in the 2015 ACC/AHA/HRS guideline 1.
Alternative Treatments
Alternatively, daily oral medications like beta-blockers (metoprolol 25-100 mg twice daily), calcium channel blockers (diltiazem 120-360 mg daily), or antiarrhythmics (flecainide 50-200 mg twice daily) can prevent recurrences, as supported by the 2015 ACC/AHA/HRS guideline 1. Some key points to consider:
- Vagal maneuvers are a simple and effective initial treatment for PSVT, with a success rate of up to 25% 1.
- Adenosine is a safe and effective medication for terminating PSVT, with a rapid onset of action and few side effects 1.
- Catheter ablation is a highly effective treatment for PSVT, with a success rate exceeding 95% for most types of PSVT 1.
- Daily oral medications can be used to prevent recurrences of PSVT, but may have potential side effects and interactions 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 2
The treatment for Paroxysmal Supraventricular Tachycardia (PSVT) is flecainide acetate tablets, USP for prevention in patients without structural heart disease.
- Key points:
- Flecainide acetate tablets, USP are indicated for the prevention of PSVT.
- The use of flecainide acetate tablets, USP should be reserved for patients in whom the benefits of treatment outweigh the risks.
- Flecainide acetate tablets, USP should not be used in patients with recent myocardial infarction.
From the Research
Treatment Options for Paroxysmal Supraventricular Tachycardia (PSVT)
- The first-line recommended treatment for stable PSVT is the use of vagal maneuvers, such as the Valsalva maneuver 3 or the modified Valsalva maneuver 4.
- Other nonpharmacologic treatments include carotid sinus massage, head-down tilt, activation of the diving reflex, and use of the pneumatic antishock garment 5.
- Pharmacologic agents, such as verapamil 5, adenosine 6, and beta-blockers 7, can be used to treat PSVT.
- For hemodynamically unstable patients, synchronized electrical countershock is the treatment of choice 5, 7.
- Catheter ablation is a highly effective treatment option for preventing recurrence of PSVT, with success rates of 94.3% to 98.5% 6.
Vagal Maneuvers
- The modified Valsalva maneuver is the most effective vagal maneuver for converting PSVT to sinus rhythm, with a high certainty of evidence 4.
- The standard Valsalva maneuver and carotid sinus massage are also effective, but with lower success rates 4.
- Vagal maneuvers are recommended as the first-line treatment for hemodynamically stable patients with PSVT 3, 6, 4, 7.