What is the treatment for Supraventricular Tachycardia (SVT)?

From the Guidelines

Supraventricular tachycardia (SVT) treatment begins with vagal maneuvers like the Valsalva maneuver or carotid sinus massage to slow the heart rate, as recommended by the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1. If these fail, intravenous adenosine is the first-line medication, typically given as a 6 mg rapid bolus, followed by a 12 mg dose if needed, with a success rate of 90% to 95% in converting orthodromic AVRT 1. For ongoing management, calcium channel blockers like verapamil (5-10 mg IV) or diltiazem (0.25 mg/kg IV), or beta-blockers such as metoprolol (5 mg IV) may be used, with success rates of 80% to 98% in terminating SVT 1. In hemodynamically unstable patients, immediate synchronized cardioversion at 50-100 joules is recommended, as it is highly effective in terminating AVRT and avoids complications associated with antiarrhythmic drug therapy 1. For long-term management, catheter ablation offers a definitive cure with success rates over 90%, and is considered first-line therapy for treatment of symptomatic SVT, providing the potential for definitive cure without the need for chronic pharmacological therapy 1. Alternatively, daily medications like beta-blockers (metoprolol 25-100 mg twice daily) or calcium channel blockers (diltiazem 120-360 mg daily) can prevent recurrences, by interrupting the reentry circuit or slowing conduction through the AV node that sustains the abnormal rapid heart rhythm 1. Patients should be educated about proper vagal maneuver techniques and when to seek emergency care for severe symptoms, and the use of adenosine, beta-blockers, and calcium channel blockers should be guided by the most recent guidelines, including the 2020 ESC guidelines for the management of patients with supraventricular tachycardia 1.

Some key points to consider in the treatment of SVT include:

• The importance of vagal maneuvers as the initial treatment, with a success rate of 27.7% in converting SVT 1
• The use of adenosine as the first-line medication, with a success rate of 90% to 95% in converting orthodromic AVRT 1
• The role of calcium channel blockers and beta-blockers in ongoing management, with success rates of 80% to 98% in terminating SVT 1
• The recommendation for synchronized cardioversion in hemodynamically unstable patients, as it is highly effective in terminating AVRT and avoids complications associated with antiarrhythmic drug therapy 1
• The consideration of catheter ablation as a definitive cure, with success rates over 90%, and the potential for first-line therapy for treatment of symptomatic SVT 1.

Overall, the treatment of SVT should be guided by the most recent guidelines, including the 2015 ACC/AHA/HRS guideline and the 2020 ESC guidelines, and should prioritize the use of vagal maneuvers, adenosine, calcium channel blockers, and beta-blockers, as well as the consideration of catheter ablation as a definitive cure.

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

Verapamil does not induce peripheral arterial spasm. Verapamil has a local anesthetic action that is 1. 6 times that of procaine on an equimolar basis. It is not known whether this action is important at the doses used in man. Verapamil does not alter total serum calcium levels. By interrupting reentry at the AV node, verapamil can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardias (PSVT), including PSVT associated with Wolff-Parkinson-White syndrome.

Svt treatment options include:

• Flecainide acetate tablets, USP for the prevention of paroxysmal supraventricular tachycardias (PSVT) in patients without structural heart disease 2
• Verapamil hydrochloride for restoring normal sinus rhythm in patients with paroxysmal supraventricular tachycardias (PSVT) by interrupting reentry at the AV node 3

From the Research

Treatment Options for Supraventricular Tachycardia (SVT)

• Vagal maneuvers, such as the Valsalva maneuver, are commonly used as a first-line treatment for SVT, with a success rate of around 19-54% 4, 5, 6
• The modified Valsalva maneuver has been shown to be effective in treating SVT, with a success rate of 43% 7
• Adenosine is also used as a first-line treatment for SVT, with a success rate of 91% 7
• Catheter ablation is a highly effective treatment for preventing recurrence of SVT, with a success rate of 94.3-98.5% 7
• Pharmacotherapy, including calcium channel blockers, β-blockers, and antiarrhythmic agents, is also used to manage SVT, although the evidence for its effectiveness is limited 7, 8

Comparison of Treatment Options

• The Valsalva maneuver and carotid sinus massage have been compared in terms of their effectiveness in terminating SVT, with no significant difference found between the two 5
• The effectiveness of the Valsalva maneuver in terminating SVT has been found to vary depending on the study, with success rates ranging from 19.4% to 54.3% 5, 6

Recommendations for Treatment

• The European Society of Cardiology guidelines recommend the use of vagal maneuvers and adenosine as first-line therapies for SVT 8
• Catheter ablation is recommended as a first-line therapy for preventing recurrence of SVT 7
• Pharmacotherapy is recommended as a management option for SVT, although the evidence for its effectiveness is limited 7, 8