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Vagal Maneuvers
The first-line treatment in hemodynamically stable patients, vagal maneuvers,
such as breath-holding and the Valsalva maneuver (ie, having the patient bear
down as though having a bowel movement), slow conduction in the AV node
and can potentially interrupt the reentrant circuit.
Carotid massage
If doctor applies pressure to an artery in your neck, it may help
to slow the heart rate. However, it can be dangerous to do on
elderly people and doctor will need to check whether you're
suitable for this technique. Due to the risk of stroke from emboli,
auscultate for bruits before attempting this maneuver
Typical adverse effects of adenosine include flushing, chest pain, and dizziness.
These effects are temporary because adenosine has a very short half-life of 1020 seconds.[54]
Electrical cardioversion
Electrical cardioversion is the most effective method for restoring sinus rhythm.
Synchronized cardioversion starting at 50J can be used immediately in patients
who are hypotensive, have pulmonary edema, have chest pain with ischemia, or
are otherwise unstable.
This uses an electric shock to restore your rapid heartbeat back to normal.
Hospital treatment
Electrophysiological study. In this test, a thin, flexible wire (catheter) is passed
through a vein in your groin or arm to your heart. The wire records your heart's
electrical activity. Your doctor can use the wire to electrically stimulate your
heart and it will burn or freeze any tissue that's disrupting or causing abnormal
electrical signals.
Types of medicine that can help control your heart rate and
rhythm. These include beta-blockers, calcium-channel blockers
and antiarrhythmic medicines. You can also take them to prevent
further SVT episodes.
Antiarrhythmic agents
Flecainide blocks sodium channels, producing a dose-related decrease in
intracardiac conduction in all parts of heart. The drug increases electrical
stimulation of threshold of ventricle, HIS-Purkinje system. Flecainide shortens
phase 2 and 3 repolarization, resulting in a decreased action potential duration
and effective refractory period.
This agent is indicated for the treatment of paroxysmal atrial fibrillation/flutter
(PAF) associated with disabling symptoms. It is also indicated for paroxysmal
SVTs, including atrioventricular nodal reentrant tachycardia (AVNRT),
atrioventricular Other alternatives for the acute treatment of SVT include
calcium channel blockers, such as verapamil and diltiazem, as well as beta-
Flecainide (Tambocor)
Reentrant tachycardia (AVRT), and other SVTs of unspecified mechanism
associated with disabling symptoms in patients without structural heart disease.
In addition, Flecainide is indicated for the prevention of documented, lifethreatening ventricular arrhythmias, such as sustained ventricular tachycardia. It
is not recommended for less severe ventricular arrhythmias, even if patients are
symptomatic.
Propafenone is indicated for the treatment of documented, life-threatening
ventricular arrhythmias, such as sustained ventricular tachycardia. It appears to
be effective in the treatment of SVTs, including atrial fibrillation and flutter. The
drug is not recommended for patients with less severe ventricular arrhythmias,
even if the patients are symptomatic.
Digoxin (Lanoxin)
Digoxin indirectly increases vagal activity, thereby decreasing conduction
velocity through the AV node. This can result in termination of paroxysmal
SVT.
Calcium Channel Blockers
Class Summary
short half-life of 8 min allows for titration to the desired effect and quick
discontinuation if needed.
Metoprolol (Lopressor, Toprol XL)
Metoprolol is a selective beta-1 adrenergic receptor blocker that decreases the
automaticity of contractions. During intravenous administration, carefully
monitor blood pressure, heart rate, and ECG.
Beta-blockers, Nonselective
Class Summary
These agents increase the refractory period of the AV node. Beta-blockers that
are effective in treating paroxysmal SVT include propranolol, esmolol,
metoprolol, atenolol, and nadolol.
Nadolol (Corgard)
Nadolol is frequently prescribed because of its long-term effect. It reduces the
effect of sympathetic stimulation on the heart. Nadolol decreases conduction
through the AV node and has negative chronotropic and inotropic effects.
Patients with asthma should use cardioselective beta-blockers.