Management of Supraventricular Tachycardia

Acute Management

The American Heart Association recommends first determining if the patient is hemodynamically stable or unstable, with signs of instability including hypotension, altered mental status, signs of shock, chest pain, or acute heart failure symptoms 1, 2
For hemodynamically unstable patients, immediate synchronized cardioversion is recommended as first-line treatment, with resuscitation equipment readily available 4, 3
For hemodynamically stable patients, vagal maneuvers such as the Valsalva maneuver or carotid sinus massage should be attempted first, followed by adenosine as first-line pharmacological therapy if vagal maneuvers fail 4
Adenosine is effective in 90-95% of patients with SVT, and potential side effects include brief flushing, chest discomfort, and shortness of breath 4

The American College of Cardiology recommends intravenous beta blockers, diltiazem, or verapamil for patients who do not respond to adenosine, with caution advised when using verapamil in patients with pre-excitation 1, 2
Oral beta blockers, diltiazem, or verapamil are recommended for long-term management of symptomatic SVT, with electrophysiology study with catheter ablation considered for definitive treatment 1, 2

The American Heart Association advises against unnecessary invasive coronary evaluation based solely on troponin elevation in the setting of SVT, and recommends caution when using calcium channel blockers in patients with pre-excitation 5, 6
Patients should be educated on proper vagal maneuver technique for self-management, and advised to reduce or eliminate caffeine intake to prevent SVT triggers 1, 2