From the Guidelines
Adenosine is the primary medication for supraventricular tachycardia (SVT) that targets heart rate with minimal effects on blood pressure, as it temporarily blocks electrical conduction in the AV node without significantly affecting blood pressure 1.
Medications for SVT
There are several medications that can help control heart rate in SVT patients with minimal impact on blood pressure. These include:
- Adenosine, which is given as a rapid IV push at 6mg initially, followed by 12mg if needed after 1-2 minutes 1
- Calcium channel blockers with nodal selectivity like verapamil and diltiazem, which primarily slow conduction through the AV node 1
- Beta-blockers such as metoprolol or atenolol, though they may have some blood pressure effects 1
Treatment Approach
The choice of medication depends on the specific type of SVT, patient characteristics, and whether treatment is for acute termination or long-term prevention.
- For acute SVT termination, adenosine is the first-line medication due to its effectiveness and minimal side effects 1
- For long-term management, calcium channel blockers and beta-blockers can be effective options 1
Patient Considerations
It's essential to consider the patient's specific condition, such as Wolff-Parkinson-White syndrome, when selecting a medication.
- For patients with Wolff-Parkinson-White syndrome, flecainide or propafenone might be used 1 These medications work by affecting the electrical conduction system of the heart rather than directly impacting vascular tone, which is why they can control heart rate while having minimal impact on blood pressure.
From the FDA Drug Label
Esmolol hydrochloride injection is a beta adrenergic blocker indicated for the short-term treatment of: Control of ventricular rate in supraventricular tachycardia including atrial fibrillation and atrial flutter and control of heart rate in noncompensatory sinus tachycardia Esmolol hydrochloride injection is indicated for the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short-term control of ventricular rate with a short-acting agent is desirable
The medication esmolol (IV) can help with heart rate in SVT, but it also has an effect on blood pressure, as it is a beta adrenergic blocker that can cause hypotension. Therefore, it is not a medication that can help with heart rate without having any effect on blood pressure 2, 2.
From the Research
Medications for SVT with No Effect on Blood Pressure
There are several medications that can help with heart rate in SVT patients without affecting blood pressure.
- Calcium channel blockers, such as verapamil and diltiazem, have been shown to be effective in terminating SVT with minimal effects on blood pressure 3, 4, 5.
- These medications can be administered through slow infusion, which reduces the risk of hypotension 3, 5.
- Adenosine is another medication commonly used to treat SVT, and it has been shown to have no significant effect on blood pressure 3, 4.
- A study comparing adenosine and calcium channel antagonists found that both medications were effective in terminating SVT, with no significant difference in the rate of reversion to sinus rhythm 4.
- Another study found that slow infusion of calcium channel blockers was safe and efficacious in terminating SVT, with no difference in success rates between verapamil and diltiazem infusions 5.
- A review of treatment options for PSVT found that calcium channel blockers, such as verapamil and diltiazem, were effective in managing PSVT, and that adenosine was also a viable option 6.