Supraventricular Tachycardia Management

Acute Management

The American Heart Association recommends vagal maneuvers as the first-line treatment for hemodynamically stable supraventricular tachycardia (SVT) in patients, with adenosine as the recommended second-line agent due to its rapid action and short half-life 1, 2
Verapamil is an appropriate third-line agent when adenosine fails or is contraindicated for acute termination of SVT in patients 1
For hemodynamically unstable SVT, synchronized cardioversion is recommended rather than pharmacological therapy in patients 1, 2

Verapamil is contraindicated in patients with AV block greater than first degree, SA node dysfunction, decompensated heart failure, severe left ventricular dysfunction, hypotension, Wolff-Parkinson-White syndrome with atrial fibrillation or flutter, and cardiogenic shock 3
Caution is advised when administering verapamil to patients who have recently received β-blockers due to the risk of profound bradycardia and hypotension 3

Hypotension is the most common adverse effect of verapamil, and resuscitation equipment should be available during administration in patients 3
Monitoring for bradycardia and worsening heart failure is recommended in predisposed patients receiving verapamil 3

For ongoing management of recurrent SVT, oral verapamil can be initiated at 120 mg daily and titrated up to a maximum of 480 mg daily in divided doses or as a single dose with long-acting formulations in patients 3