Is discharge appropriate for a patient with supraventricular tachycardia (SVT) who has stabilized in the clinic?

Discharge is Appropriate for Patients with Stabilized SVT

Discharge is appropriate for a patient with supraventricular tachycardia (SVT) who has stabilized in the clinic, provided they have been successfully converted to sinus rhythm and remain hemodynamically stable. 1, 2

Assessment of Stability for Discharge

• Patients who have converted to sinus rhythm and show no signs of hemodynamic instability (hypotension, altered mental status, signs of shock, chest pain, or acute heart failure) are appropriate candidates for discharge 1, 2
• Successful conversion to sinus rhythm can be achieved through vagal maneuvers (27.7% success rate), adenosine (95% success rate), calcium channel blockers or beta blockers (80-98% success rate), or synchronized cardioversion 1, 3
• Patients should remain stable for a period of observation after conversion to ensure no recurrence of SVT before discharge 2

Discharge Criteria for SVT Patients

• Conversion to normal sinus rhythm with stable vital signs 1, 2
• No evidence of ongoing cardiac ischemia or heart failure 1
• Patient is able to tolerate oral medications if prescribed 1
• Patient understands warning signs that would necessitate return to medical care 2
• Follow-up with a cardiologist or electrophysiologist has been arranged 1, 4

Discharge Medications and Follow-up

• Oral beta blockers, diltiazem, or verapamil should be prescribed for ongoing management in patients with symptomatic SVT who do not have ventricular pre-excitation during sinus rhythm 1
• Patients should be referred to a cardiologist or electrophysiologist for consideration of EP study with possible ablation, which has a success rate of 94.3-98.5% 2, 5
• Patients should be educated about performing vagal maneuvers at home for recurrent episodes 3, 6

Special Considerations and Cautions

• Calcium channel blockers and beta blockers should be avoided in patients with suspected pre-excitation on ECG, as they may enhance conduction over the accessory pathway if SVT converts to AF, potentially leading to ventricular fibrillation 3, 2
• Patients with frequent recurrences, pre-excitation syndromes (like WPW), or occupations where SVT could be dangerous (pilots, bus drivers) should be referred for urgent rather than routine cardiology follow-up 1, 5
• Patients with signs of tachycardia-mediated cardiomyopathy (rare, approximately 1% of SVT patients) may require additional evaluation before discharge 5

When Discharge is Not Appropriate

• Patients with hemodynamic instability despite treatment 1
• Patients with recurrent SVT despite pharmacological therapy 1
• Patients with suspected pre-excited AF who have not been fully evaluated 3, 2
• Patients with significant comorbidities that may be exacerbated by SVT (severe coronary artery disease, heart failure) 1