From the Guidelines
Paroxysmal supraventricular tachycardia (PSVT) requires treatment when it causes significant symptoms, hemodynamic instability, or when episodes are frequent or prolonged, as indicated by the most recent guidelines 1.
Key Considerations for Treatment
- Treatment is generally indicated when patients experience symptoms such as severe palpitations, chest pain, shortness of breath, dizziness, presyncope, or syncope.
- Immediate intervention is necessary if the patient shows signs of hemodynamic compromise including hypotension, altered mental status, or signs of shock.
- For acute termination of PSVT, vagal maneuvers like the Valsalva maneuver should be attempted first, as they are effective in terminating up to 25% of PSVTs 1.
Medication Options
- If vagal maneuvers are unsuccessful, adenosine is the first-line medication, typically administered as a rapid IV bolus of 6 mg, followed by 12 mg if needed, and another 12 mg dose if the arrhythmia persists 1.
- For long-term management, beta-blockers (such as metoprolol 25-100 mg twice daily) or calcium channel blockers (such as diltiazem 120-360 mg daily in divided doses) are commonly used.
Alternative Therapies
- In patients with recurrent, symptomatic episodes despite medical therapy, catheter ablation offers a definitive treatment with success rates exceeding 95% for most forms of PSVT.
- The decision to treat is based on the frequency and severity of symptoms, impact on quality of life, and patient preference, as PSVT itself is rarely life-threatening but can significantly affect a patient's wellbeing 1.
Important Considerations
- A clinical history describing the pattern of episodes, including number, duration, frequency, mode of onset, and possible triggers, is crucial for clinical decision making 1.
- Symptoms vary with the ventricular rate, underlying heart disease, duration of SVT, and individual patient perceptions, and may lead to tachycardia-mediated cardiomyopathy if left untreated 1.
From the FDA Drug Label
In two randomized, crossover, placebo-controlled, double-blind trials of 60–90 days duration in patients with paroxysmal supraventricular arrhythmias [paroxysmal atrial fibrillation/flutter (PAF), or paroxysmal supraventricular tachycardia (PSVT)], propafenone reduced the rate of both arrhythmias The patient population in the above trials was 50% male with a mean age of 57. 3 years. Fifty percent of the patients had a diagnosis of PAF and 50% had PSVT.
Paroxysmal supraventricular tachycardia (PSVT) is concerning and would need treatment when it increases the risk of mortality or significantly impacts the patient's quality of life. However, the provided text does not specify the exact point at which PSVT becomes concerning.
- Key factors to consider when evaluating the need for treatment include the frequency and duration of episodes, as well as the presence of underlying heart disease.
- The decision to treat PSVT should be made on a case-by-case basis, taking into account the individual patient's symptoms and medical history 2.
From the Research
Concerning Symptoms of Paroxysmal Supraventricular Tachycardia
Paroxysmal supraventricular tachycardia (PSVT) is concerning and may need treatment when it presents with symptoms such as:
Indications for Treatment
Treatment is indicated for patients with PSVT who are:
- Hemodynamically unstable, in which case emergent cardioversion is recommended 3, 4
- Symptomatic and have recurrent PSVT, in which case long-term drug treatment or catheter ablation may be considered 3, 4
- At risk of developing tachycardia-mediated cardiomyopathy, although this is rare (1%) 3
Treatment Options
Treatment options for PSVT include:
- Vagal maneuvers, such as the modified Valsalva maneuver (43% effective) 3 and carotid sinus massage (10.5% effective) 5
- Intravenous adenosine (91% effective) 3
- Calcium channel blockers, β-blockers, and antiarrhythmic agents for long-term management 3
- Catheter ablation, which is safe, highly effective, and recommended as first-line therapy to prevent recurrence of PSVT (single procedure success rates of 94.3% to 98.5%) 3