From the Guidelines
The most effective treatment for supraventricular tachycardia (SVT) is to start with vagal maneuvers, followed by intravenous adenosine if necessary, as recommended by the latest guidelines 1.
Treatment Options
The treatment of SVT involves several steps, including:
- Vagal maneuvers, such as the Valsalva maneuver or carotid sinus massage, to slow the heart rate 1
- Intravenous adenosine as the first-line medication, typically given as a 6 mg rapid bolus, followed by a 12 mg dose if needed 1
- Calcium channel blockers, such as verapamil or diltiazem, or beta-blockers, such as metoprolol, for persistent SVT 1
- Synchronized cardioversion at 50-100 joules in emergency situations with hemodynamic instability 1
Long-term Management
For long-term management, catheter ablation offers a definitive cure with success rates over 90% 1. Alternatively, daily medications like beta-blockers, calcium channel blockers, or antiarrhythmics can prevent recurrences 1.
Latest Guidelines
The latest guidelines from the European Society of Cardiology (2020) recommend adenosine as the drug of choice for acute therapy of SVT when vagal maneuvers fail, and also recommend ivabradine, alone or in combination with beta-blockers, in symptomatic patients with inappropriate sinus tachycardia and postural orthostatic tachycardia syndrome 1.
Key Points
- Vagal maneuvers and adenosine are the first-line treatments for SVT
- Calcium channel blockers and beta-blockers can be used for persistent SVT
- Synchronized cardioversion is recommended in emergency situations with hemodynamic instability
- Catheter ablation offers a definitive cure for long-term management
- The latest guidelines recommend adenosine as the drug of choice for acute therapy of SVT 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 Flecainide acetate is indicated for the prevention of paroxysmal supraventricular tachycardias (PSVT) in patients without structural heart disease.
- The use of flecainide acetate for treatment of PSVT is not explicitly mentioned in the label. 2
From the Research
SVT Treatment Options
- Vagal manoeuvres, such as the Valsalva maneuver and carotid sinus massage, are commonly used to treat supraventricular tachycardia (SVT) 3, 4, 5
- The Valsalva maneuver has a success rate of 19.4% in converting SVT to sinus rhythm, while carotid sinus massage has a success rate of 10.5% 4, 5
- A modified Valsalva manoeuvre has been shown to be more effective, with a success rate of 43% 6
- Adenosine is also a commonly used treatment for SVT, with a success rate of 75% 7
- Beta-blockers and calcium channel blockers can be used as alternative therapies for SVT 3
- Catheter ablation is a curative treatment option for SVT, but is typically reserved for patients with frequent or severe symptoms 3
Considerations for Treatment
- The choice of treatment for SVT depends on several factors, including the frequency and severity of symptoms, as well as the patient's overall health and preferences 3
- Carotid sinus massage may be associated with neurologic complications, such as stroke or transient ischemic attack, and should be used with caution 7
- The modified Valsalva manoeuvre and adenosine administration require monitoring of the heart rhythm, as they can induce ventricular tachycardia or ventricular fibrillation in rare cases 7, 6