What to do after tachycardia resolves on its own?

Management After Self-Resolving Tachycardia

After tachycardia resolves on its own, the primary approach should be to identify and treat the underlying cause rather than treating the resolved tachycardia itself. 1

Initial Assessment

• Evaluate the patient's current clinical status, including vital signs, oxygen saturation, and symptoms 1
• Obtain a 12-lead ECG to document the current rhythm and look for any abnormalities that might indicate the type of tachycardia that was present 1
• Assess for signs of hemodynamic compromise or ongoing symptoms despite resolution of tachycardia 1
• Check for potential reversible causes of tachycardia, including hypoxemia, dehydration, fever, anemia, pain, anxiety, or medication effects 1

Management Based on Tachycardia Type

If Sinus Tachycardia

• Focus on identifying and treating the underlying cause (fever, dehydration, anemia, hypotension, pain, anxiety, etc.) 1
• No specific antiarrhythmic treatment is required for resolved sinus tachycardia 1
• For inappropriate sinus tachycardia (IST) that recurs, consider beta blockers or ivabradine for symptom management 1

If Supraventricular Tachycardia (SVT)

• For patients with structurally normal hearts who had a single episode that resolved spontaneously with no significant symptoms, observation may be sufficient 1
• For recurrent episodes:
  • Consider long-term therapy with calcium channel blockers (diltiazem, verapamil) or beta blockers 2
  • Refer to cardiology for consideration of electrophysiology study and possible catheter ablation, especially for symptomatic patients or those with Wolff-Parkinson-White syndrome 2

If Atrial Fibrillation/Flutter

• After spontaneous conversion to sinus rhythm, assess stroke risk using CHA₂DS₂-VASc score to determine need for anticoagulation 1
• Consider cardiology referral for evaluation of rhythm control versus rate control strategy 1
• Monitor for recurrence, especially if the episode was the first presentation 1

If Ventricular Tachycardia

• Even if self-terminated, urgent cardiology consultation is required as this represents a potentially life-threatening condition 1
• Evaluation for structural heart disease with echocardiography is essential 1
• Admission for monitoring may be warranted depending on clinical circumstances 1

Special Considerations

• For patients with congenital heart disease and resolved tachycardia, closer follow-up is warranted due to higher risk of recurrence and complications 3
• If tachycardia was prolonged before resolving, evaluate for potential tachycardia-induced cardiomyopathy, especially with atrial fibrillation 4
• For wide-complex tachycardias that resolved, ensure accurate diagnosis was made (ventricular vs. supraventricular with aberrancy) as this will guide further management 5

Follow-up Recommendations

• Schedule appropriate follow-up based on the presumed type of tachycardia and patient risk factors 1
• Consider Holter monitoring or event recorder if diagnosis is uncertain or to assess burden of arrhythmia 2
• Educate patient on warning signs that should prompt immediate medical attention (syncope, severe chest pain, severe shortness of breath) 1
• Teach vagal maneuvers for patients with recurrent SVT episodes 2

When to Seek Emergency Care

• Instruct patients to seek immediate medical attention if tachycardia recurs with:
  • Symptoms of hemodynamic compromise (lightheadedness, syncope, chest pain, shortness of breath) 1
  • Persistent heart rate >150 beats per minute 1
  • New or worsening symptoms even with lower heart rates 1