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.

Other Tips

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