Supraventricular Tachycardia Management

By Benji Ho - December 26th, 2015 | Updated February 6th, 2016

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.

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.

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.

Have a defibrillator nearby when administering meds.
Cryoablation has less risk of heart block than radioablation but has higher rate of recurrence of SVT.