Initial Treatment for Supraventricular Tachycardia (SVT) in Pregnant Women

Treatment Algorithm for SVT in Pregnancy

• The American Heart Association recommends vagal maneuvers as the first-line intervention for initial treatment of SVT in pregnant women, followed by adenosine if vagal maneuvers fail 1, 2, 3
• Vagal maneuvers should be performed with the patient in the supine position, and may include the Valsalva maneuver, carotid sinus massage, or cold stimulus 1, 4
• The Valsalva maneuver has been shown to be more successful than carotid sinus massage in terminating SVT 1
• Intravenous adenosine is recommended when vagal maneuvers fail, with an initial dose of 6 mg rapid IV bolus, and up to 2 subsequent doses of 12 mg may be administered if ineffective 1, 2, 4
• Adenosine is safe for the fetus due to its short half-life, and maternal side effects are usually transient 1
• Intravenous beta-blockers, such as metoprolol or propranolol, may be used when adenosine is ineffective or contraindicated, and are considered safe in pregnancy 1, 2, 3
• Synchronized cardioversion is recommended when pharmacological therapy is ineffective or contraindicated, and is safe at all stages of pregnancy 1, 2
• Medications should be avoided if possible during the first trimester, and the lowest recommended dose should be used with regular monitoring of clinical response 1, 4
• The American College of Cardiology recommends avoiding pressure to the eyeball as a vagal maneuver, as it is potentially dangerous 1