Cardiovascular Medicine Book

Approach

Atrial Fibrillation

Bradycardia

Information Resources

Miscellaneous

Symptoms

Tachycardia

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Supraventricular Tachycardia Management in the Adult - Old Guidelines

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  1. See Also
    1. Supraventricular Tachycardia Management in the Adult (current guidelines)
  2. Background
    1. Old Guidelines shown for historical reasons and to look at SVT from a different approach
    2. Follow new guidelines in choosing medications to treat SVT
  3. Management: Step 1 - Stable SVT
    1. See Unstable Tachycardia if unstable
    2. Regular SVT
      1. See Step 2 below
    3. Irregular SVT: Atrial Fibrillation (or flutter, MAT)
      1. Consider expert consultation
      2. Control Heart Rate
        1. Diltiazem
        2. Beta Blockers (avoid in COPD or uncompensated CHF)
  4. Management: Step 2 - Regular SVT
    1. See Unstable Tachycardia if unstable
    2. Vagal stimulation
      1. Carotid Massage (avoid if risk of embolism)
      2. Valsalva maneuver
    3. Adenosine
      1. First: 6 mg rapid IV push over 1-3 seconds
      2. Second: 12 mg rapid IV push over 1-3 seconds
    4. Assess QRS Complex morphology and timing
      1. Junctional tachycardia
      2. Paroxysmal Supraventricular Tachycardia
      3. Ectopic or Multifocal Atrial Tachycardia
      4. Confirm not wide-complex tachycardia
        1. Calcium Channel Blockers contraindicated
  5. Management: Step 3 - Regular SVT
    1. Rhythm converts with vagal maneuvers or Adenosine
      1. Consistent with re-entry SVT
      2. Protocol for recurrence of SVT
        1. Repeat Adenosine dose or
        2. Diltiazem or
        3. Beta Blockers
    2. Rhythm does not convert with vagal maneuvers, Adenosine
      1. Consider Atrial flutter, ectopic or junctional rhythm
      2. Consider expert consultation
      3. Control Heart Rate
        1. Diltiazem
        2. Beta Blockers (avoid in COPD or uncompensated CHF)

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