Supraventricular Tachycardia Management

Types of SVT:

• AVNRT – caused by a slow and fast pathway in the node, causing reentry.
• AVRT – caused by an accessory pathway between the atrium and ventricle, not in the node. If there is delta wave and tachycardia, it is WPW.
• Atrial Tachycardia – caused by focal area of automaticity in atrium.

Acute Treatment

• Vagal Maneuvers – Valsalva x15 sec. Carotid massage not preferred because could dislodge plaque causing stroke. If not effective, use meds.
• Adenosine – first line acute treatment for SVT and wide complex tachycardia. Quick onset, short half-life, and highly effective.
• Verapamil, Diltiazem, or Metoprolol – use for SVT if adenosine doesn’t work
• Procainamide, Amiodarone, or Sotalol – use for wide complex tachycardia if adenosine doesn’t work.
• If meds not working and pt still unstable, then do synchronized cardioversion.

Long Term Treatment

• Diltiazem 120mg+ Propranolol 80mg, or Flecainide 3mg/kg PRN – if infrequent (“pill-in-the-pocket”)
• Verapamil, Diltiazem, or beta blockers – for AVNRT if frequent
• Flecainide or Propafenone (Ic antiarrhythmics, Na channel blockers) – for AVRT, ATach, if frequent
• Catheter Ablation – if WPW, or if meds not working.

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