Supraventricular Tachycardia

Obtain a 12-lead ECG whenever feasible, continuous rhythm monitoring, blood pressure, and assessment for hypotension, heart failure, chest pain, or altered mental status. These findings identify poorly tolerated SVT and support immediate treatment and arrhythmia-specialist referral rather than observation alone. ScienceDirect+1ScienceDirectParoxysmal Supraventricular Tachycardia - an overviewACC[PDF] SUPRAVENTRICULAR TACHYCARDIA (SVT) TOOLKIT

For hemodynamically unstable SVT, perform synchronized electrical cardioversion. If the patient is stable enough for an initial attempt at vagal maneuvers or adenosine, cardioversion remains indicated when these measures are ineffective, contraindicated, or not feasible. ScienceDirect+1ScienceDirectParoxysmal Supraventricular Tachycardia - an overviewACC[PDF] SUPRAVENTRICULAR TACHYCARDIA (SVT) TOOLKIT

Use ECG regularity and QRS width as safety gates. A regular narrow-complex tachycardia is the setting for an AV-nodal intervention strategy. A regular wide-complex tachycardia may be ventricular tachycardia, SVT with aberrancy, or accessory-pathway conduction; if the mechanism is uncertain, manage it as an undifferentiated wide-complex tachycardia rather than reflexively administering AV-nodal blockers. PubMedPubMedWolff-Parkinson-White Syndrome - StatPearls - NCBI Bookshelf

For stable regular SVT of unknown mechanism, perform vagal maneuvers and/or administer IV adenosine as first-line treatment. Initial management of regular narrow-complex tachycardia is generally directed at slowing AV nodal conduction. BMJ+1BMJDiagnosis and management of supraventricular tachycardia - The BMJACC[PDF] SUPRAVENTRICULAR TACHYCARDIA (SVT) TOOLKIT

If adenosine is ineffective, not feasible, or the rhythm recurs, IV beta-blocker, IV diltiazem, or IV verapamil is an alternative for stable regular SVT. In one emergency-department study of spontaneous SVT, slowly infused verapamil or diltiazem converted 98% compared with 86.5% for adenosine; mean post-conversion blood pressure fell with calcium-channel blockers, and hypotension occurred in 1 of 102 patients receiving a calcium-channel blocker. ScienceDirect+1ScienceDirectSlow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardiaACC[PDF] SUPRAVENTRICULAR TACHYCARDIA (SVT) TOOLKIT

When choosing a nondihydropyridine calcium-channel blocker, avoid rapid bolus administration in patients with marginal blood pressure. Historical rapid infusion was associated with hypotensive episodes; a slow-infusion study used verapamil at 1 mg/min and diltiazem at 2.5 mg/min, with conversion exceeding 97% and hypotension in approximately 1% of participants. ScienceDirect+1ScienceDirectSlow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia - ScienceDirectScienceDirectSlow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia

AVNRT and AVRT are common reentrant causes of PSVT. AVNRT depends on fast and slow AV nodal pathways, whereas AVRT uses an accessory pathway; ablation therefore targets the AV nodal slow pathway for AVNRT and the accessory pathway for AVRT. PubMed+1PubMedParoxysmal Supraventricular Tachycardia - StatPearls - NCBI Bookshelfpublications aapLong-Term Clinical Outcomes From Catheter Ablation of SVT

A resting ECG showing manifest pre-excitation should trigger arrhythmia-specialist referral. In a patient with WPW pattern and a stable regular narrow tachycardia consistent with orthodromic AVRT, use vagal maneuvers followed by adenosine as first-line therapy; beta-blockers or calcium-channel blockers are described as second-line agents, with cardioversion reserved for refractory rhythm. PubMed+1PubMedWolff-Parkinson-White Syndrome - StatPearls - NCBI BookshelfACC[PDF] SUPRAVENTRICULAR TACHYCARDIA (SVT) TOOLKIT

Do not extrapolate the orthodromic AVRT pathway to a wide-complex rhythm with possible pre-excitation or aberrancy. In this setting, uncertainty about rhythm mechanism is itself a reason to avoid routine AV-nodal blockade and use a wide-complex tachycardia approach. PubMedPubMedWolff-Parkinson-White Syndrome - StatPearls - NCBI Bookshelf

Suspect atrial tachycardia when abnormal P waves are identifiable or become apparent during transient AV block, particularly in patients with structural heart disease. Surface ECG interpretation and Holter analysis can refine the diagnosis and can direct mapping to anatomic regions of interest when catheter ablation is planned. PubMed+1PubMedElectrocardiographic Diagnosis of Atrial Tachycardia: Classification, P‐Wave Morphology, and Differential Diagnosis with Other Supraventricular Tachycardias - PMCACC[PDF] SUPRAVENTRICULAR TACHYCARDIA (SVT) TOOLKIT

Offer electrophysiology study and catheter ablation as first-line definitive treatment for symptomatic PSVT when the patient is an ablation candidate and prefers a curative strategy. Contemporary sources describe excellent success with relatively low complication rates for AVNRT and AVRT, and ablation can reduce recurrent hospitalization and reliance on long-term medication. PubMed+1PubMedParoxysmal Supraventricular Tachycardia - StatPearls - NCBI BookshelfPubMedSupraventricular Tachycardia - StatPearls - NCBI Bookshelf - NIH

For regular SVT of unknown mechanism, patients who are candidates for and prefer ablation should undergo electrophysiology study with catheter ablation. If medical therapy is selected, beta-blockers, diltiazem, or verapamil are options only in the absence of pre-excitation; flecainide or propafenone are options in the absence of structural heart disease. ACCACC[PDF] SUPRAVENTRICULAR TACHYCARDIA (SVT) TOOLKIT

For patients who cannot undergo or decline ablation and do not respond to simpler agents, amiodarone, dofetilide, or sotalol are listed as lower-strength ongoing options; digoxin is an option only when pre-excitation is absent. These drugs require individualized selection because the source algorithm does not provide dosing or monitoring specifications. ACCACC[PDF] SUPRAVENTRICULAR TACHYCARDIA (SVT) TOOLKIT

Manifest pre-excitation materially lowers the threshold for electrophysiology referral. Ablation may be considered even without symptoms when the accessory pathway has a short refractory period, and is strongly recommended for high-risk occupations. PubMedPubMedParoxysmal Supraventricular Tachycardia - StatPearls - NCBI Bookshelf