What are the treatments for tachycardia (rapid heart rate)?

From the Guidelines

For the treatment of tachycardia, intravenous beta blockers, diltiazem, or verapamil is recommended for acute treatment in hemodynamically stable patients 1. The management of tachycardia involves a combination of lifestyle modifications and pharmacological interventions.

Initial Management

For immediate management of mild episodes, try vagal maneuvers like taking slow, deep breaths, splashing cold water on your face, or gently massaging your carotid sinus (neck area). Stay hydrated and avoid stimulants like caffeine, alcohol, and nicotine.

Pharmacological Interventions

If prescribed, take medications such as:

• Beta-blockers (metoprolol, propranolol)
• Calcium channel blockers (verapamil, diltiazem) exactly as directed 1.

Long-term Management

For long-term management, identify and address triggers like stress, anxiety, or certain foods. Regular exercise, adequate sleep, and stress reduction techniques can help prevent episodes. If your tachycardia is accompanied by chest pain, shortness of breath, dizziness, or fainting, seek emergency medical attention immediately. Tachycardia occurs when electrical signals in your heart malfunction, causing it to beat faster than normal (usually over 100 beats per minute at rest), and the underlying cause needs to be identified for effective treatment. Some key points to consider when treating tachycardia include:

• Adenosine can be useful in the acute setting to either restore sinus rhythm or diagnose the tachycardia mechanism in patients with suspected focal AT 1.
• Synchronized cardioversion is recommended for acute treatment in patients with hemodynamically unstable focal AT 1.
• Procainamide is recommended for patients with hemodynamically stable monomorphic VT (mVT) who do not have severe congestive heart failure or acute myocardial infarction (AMI) 1.

From the FDA Drug Label

ADENOSINE INJECTION, USP for intravenous use INDICATIONS AND USAGE Adenosine Injection, a pharmacologic stress agent, is indicated as an adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately DOSAGE AND ADMINISTRATION Recommended dose is 0.14 mg/kg/min infused over six minutes as a continuous peripheral intravenous infusion

• Adenosine can be used to treat supraventricular tachycardia (SVT), including paroxysmal supraventricular tachycardia (PSVT), by slowing the heart rate 2.
• Metoprolol can be used to treat tachycardia associated with thyrotoxicosis, hypertension, and angina by reducing the heart rate and contractility of the heart 3.
• Verapamil can be used to treat tachycardia associated with atrial fibrillation and atrial flutter by slowing the heart rate and reducing the contractility of the heart 4.

Key treatments for tachycardia:

• Adenosine for SVT and PSVT
• Metoprolol for thyrotoxicosis, hypertension, and angina
• Verapamil for atrial fibrillation and atrial flutter

From the Research

Treatments for Tachycardia

The following are treatments for tachycardia:

• Vagal maneuvers: The first treatment option for ending stable narrow QRS complex SVTs 5, 6, 7
• Adenosine: Effective in the acute setting, especially when vagal maneuvers fail 5, 6, 7, 8
• Calcium channel blockers (diltiazem or verapamil): Can be used acutely or as long-term therapy 5, 6, 7, 8
• Beta blockers (metoprolol): Can be used acutely or as long-term therapy 6
• Class Ic antiarrhythmics (flecainide or propafenone): Can be used long-term 6
• Class Ia antiarrhythmics (quinidine, procainamide, or disopyramide): Used less often due to modest effectiveness and adverse effects 6
• Class III antiarrhythmics (amiodarone, sotalol, or dofetilide): Effective, but have potential adverse effects and should be administered in consultation with a cardiologist 6
• Catheter ablation: Has a success rate of 95% and recurrence rate of less than 5%, and causes inadvertent heart block in less than 1% of patients 6
• Digoxin: May be used as an alternative in difficult scenarios and resource-limited settings, but its use should be further investigated 5
• Electricity (synchronized cardioversion): The preferred form of treatment for unstable patients 5, 7

Treatment Approach

The approach to treatment depends on the patient's stability:

• Hemodynamically stable patients: Treated with vagal maneuvers, intravenous adenosine, diltiazem, or verapamil 7
• Hemodynamically unstable patients: Treated with cardioversion 7
• Symptomatic and recurrent PSVT: Can be treated with long-term drug treatment or catheter ablation 7