Supraventricular Tachycardia - Overview

Atrial fibrillation is the most common type of supraventricular tachycardia. For information on this condition, see the topic Atrial Fibrillation. If you have ventricular tachycardia, see the topic Ventricular Tachycardia.

What is supraventricular tachycardia?

Supraventricular tachycardia (SVT) is an abnormal fast heart rhythm that starts in the upper chambers, or the atria, of the heart. (Supraventricular means above the ventricles, tachy means fast, and cardia means heart.) Normally, the heart's electrical system precisely controls the rhythm and rate at which the heart beats. In supraventricular tachycardia, abnormal electrical connections (or abnormal firing of the connections) cause the heart to beat too fast. Typically, during supraventricular tachycardia episodes, the heart speeds up to rates of 150 to 200 beats per minute and occasionally as high as 300. After some time, the heart returns to a normal rate (60 to 100 beats per minute) on its own or after treatment. Supraventricular tachycardia (SVT) is also called paroxysmal supraventricular tachycardia (PSVT) or paroxysmal atrial tachycardia (PAT).

What are the different types of supraventricular tachycardia?

Sometimes it is normal to have an increased heart rate-for example, during exercise, with a high fever, or when under stress. This fast heart rate, called sinus tachycardia, is a normal response to these stressors and is not considered a medical problem. This topic addresses the types of supraventricular tachycardias that are considered abnormal. These include: Atrioventricular nodal reentrant tachycardia (AVNRT), the most common type (after atrial fibrillation). Atrioventricular reciprocating tachycardia (AVRT), including Wolff-Parkinson-White syndrome.

What causes supraventricular tachycardia?

Most supraventricular tachycardia results from abnormal electrical connections in the heart that short-circuit the normal electrical system. What causes these abnormal pathways is not clear. In the case of Wolff-Parkinson-White syndrome, the condition may be inherited in some cases. Overly high levels of the heart medication digoxin (such as Lanoxicaps or Lanoxin) can cause supraventricular tachycardia. Rarely, conditions that affect the lungs-such as chronic obstructive pulmonary disease (COPD), pneumonia, heart failure, and pulmonary embolism-can also cause a type of SVT called multifocal atrial tachycardia (MAT).

What are the symptoms?

With supraventricular tachycardia, you may have palpitations, an uncomfortable feeling that your heart is racing or pounding. You may also notice that your pulse is rapid or see or feel your pulse pounding, especially at your neck, where large arteries are close to the skin. Additional symptoms include feeling dizzy or lightheaded, near-fainting or fainting (syncope), shortness of breath, chest pain, throat tightness, and sweating.

How is supraventricular tachycardia diagnosed?

A description of your symptoms is one of the most important clues in diagnosing supraventricular tachycardia.Your doctor will ask what, if anything, triggers the episodes, how long they last, and whether anything stops them. Because supraventricular tachycardia is a problem with your heart's electrical system, the most important test is electrocardiogram (EKG, ECG). An EKG measures the heart's electrical activity and can record supraventricular tachycardia episodes. An EKG is usually done along with a medical history and physical examination, lab tests, and a chest X-ray. If you do not have an episode of supraventricular tachycardia while at the doctor's office, your doctor will probably ask you to wear a portable EKG to record your heart rhythm on a continuous basis. This is referred to by several names, including ambulatory electrocardiogram, ambulatory ECG, Holter monitoring, 24-hour EKG, or cardiac event monitoring. This will allow your heart rhythm to be recorded while you are having supraventricular tachycardia. Your doctor may also recommend an electrophysiology (EP) study. In this test, flexible wires are inserted into a vein, usually in the groin, and threaded into the heart. Electrodes at the end of the wires send information about the heart's electrical activity. In this way, the EP study can map any abnormal electrical activity, identify the type of supraventricular tachycardia you have, and guide treatment.

How is it treated?
Some supraventricular tachycardias do not cause symptoms and may not need treatment. However, when symptoms occur, treatment is usually recommended. Your doctor may teach you how to perform vagal maneuvers, such as the Valsalva maneuver or coughing, to slow your heart rate. If vagal maneuvers do not work, a fast-acting intravenous (IV) medication such as adenosine or verapamil can be given. If the arrhythmia does not stop and symptoms are severe, electrical cardioversion, in which a brief electric shock is given to the heart to reset the heart rhythm, may be needed. If supraventricular tachycardia recurs, you may need long-term treatment, including: Beta-blocker or other antiarrhythmic medications to slow heart rate. Catheter ablation, which is usually done during an electrophysiology (EP) study. Radio waves (radiofrequency energy) are directed through the catheter to the specific heart tissue that is generating abnormal electrical impulses. The radio waves cause the area of the heart muscle to be heated and selectively destroyed, eliminating the SVT.

What precautions should I take?

Avoid consuming alcohol, coffee, and chocolate, which may provoke episodes of supraventricular tachycardia. Also, nonprescription decongestants, herbal remedies, diet pills, and "pep" pills often contain stimulants and should be avoided. Illegal drugs, such as cocaine, ecstasy, or methamphetamine, also can trigger episodes. It is important to be aware of which substances have an effect on you and to avoid them.

Supraventricular Tachycardia - Treatment Overview

Supraventricular tachycardia is usually treated if: You have symptoms such as dizziness, chest pain, or fainting (syncope) that are caused by your fast heart rate. Your episodes of fast heart rate are occurring more frequently or do not revert to normal on their own.

Treatment for sudden-onset (acute) episodes

When episodes of supraventricular tachycardia (SVT) start suddenly and cause symptoms, you can try vagal maneuvers-such as gagging, holding your breath and bearing down (Valsalva maneuver), immersing your face in ice-cold water (diving reflex), coughing, or putting pressure on your eyelids. These simple maneuvers stimulate the vagus nerve, which can slow conduction of electrical impulses that control your heart rate. Your doctor will teach you how to perform vagal maneuvers safely. Your doctor may also prescribe a short-acting medication that you can take by mouth if vagal maneuvers don't work. This allows some people to manage their SVT without having to visit the emergency room repeatedly. If your heart rate cannot be slowed using vagal maneuvers, you may have to go to your doctor's office or the emergency room, where a fast-acting medication such as adenosine or verapamil can be given. If the arrhythmia does not stop and symptoms are severe, electrical cardioversion, which uses an electrical current to reset the heart rhythm, may be needed.

Ongoing treatment of recurring supraventricular tachycardia

If you have recurring episodes of supraventricular tachycardia, you may need to take medications, either on an as-needed basis or daily. Medication treatment typically includes betablockers, calcium channel blockers, other antiarrhythmic medications, or digoxin. In people with frequent episodes, treatment with medications can decrease recurrences. However, these medications often have side effects.

Many people with supraventricular tachycardia have a procedure called catheter ablation, which blocks abnormal electric impulses and can eliminate supraventricular tachycardia and the need to take medications. However, this procedure has risks, including infection, bleeding, and injury to the heart. You must balance your feelings about taking medication for the rest of your life with having an invasive procedure. Additionally, catheter ablation (also called radiofrequency ablation) is not available everywhere and is best performed in a medical center that has staff experienced with this complicated procedure.

Treatment for atrioventricular nodal reentrant tachycardia (AVNRT)

In the case of atrioventricular nodal reentrant tachycardia (AVNRT), medications can be takeneither daily or only when the fast heart beat arises-or catheter ablation may be done. If you have infrequent episodes of AVNRT that last hours but do not cause severe symptoms, your doctor may recommend that you take medications only when you have an episode. These medications include the antiarrhythmic medications propafenone, the calcium channel blocker verapamil, and the beta-blocker propranolol.1 Your doctors may recommend daily doses of calcium channel blockers, beta-blockers, and/or digoxin if you have frequent episodes of AVNRT. If these medications are not effective in stopping supraventricular tachycardia from recurring, your doctor may recommend that you take an antiarrhythmic medication.

If you take daily medication for AVNRT or you have significant symptoms, you may want to consider having catheter ablation. In a recent study, this procedure eliminated AVNRT in 96% of cases. However, catheter ablation poses risks, and in rare cases the arrhythmia recurs, which may require a second procedure.1

Treatment for atrioventricular reciprocating tachycardia (AVRT)

In the case of atrioventricular reciprocating tachycardia (AVRT), you can take medications for recurrent episodes either on an as-needed or daily basis, depending on how frequently they occur. These medications-which include digoxin, beta-blockers, and the calcium channel blockers verapamil and diltiazem-are often effective in stopping or preventing episodes of AVRT. However, in some people with a type of AVRT called Wolff-Parkinson-White (WPW) syndrome, these medications may result in extremely fast heart rates that can lead to lightheadedness, fainting (syncope), and even death. Treatment of WPW frequently requires antiarrhythmic medications, such as propafenone (Rythmol), that slow electrical conduction over the extra connection. Catheter ablation is often recommended for people with WPW, especially those who have severe symptoms or also have atrial fibrillation or flutter. This procedure can successfully eliminate WPW more than 95% of the time. There is a small risk (5%) of the arrhythmia recurring even after successful ablation of WPW.1 However, a second session of catheter ablation is usually successful.

Supraventricular Tachycardia - Medications

If you have symptoms, medications may be used to treat supraventricular tachycardia.

Medication Choices
For severe symptoms, such as chest pain, shortness of breath, or feeling faint, you may be given fast-acting antiarrhythmic medications by health professionals in the hospital emergency department, where your heart can be monitored. Fast-acting antiarrhythmic medications commonly used to slow the heart rate during an episode include: Adenosine. Calcium channel blockers (specifically verapamil and diltiazem). Beta-blockers (specifically propranolol, metoprolol, or esmolol).

Long-term use of an antiarrhythmic medication may also be needed to reduce the chance of having more episodes of supraventricular tachycardia or to reduce the heart rate during these episodes. Common medications used for this purpose include: Beta-blockers. Calcium channel blockers. Digoxin. Other antiarrhythmic medications.

What to Think About

All medications have side effects. See a table of medications that may interact with other medications and with pacemakers and implantable cardioverter defibrillators (ICDs).

Beta-blockers for fast heart rates

Examples acebutolol Sectral atenolol Tenormin esmolol Brevibloc metoprolol Lopressor Toprol XL nadolol Corgard propranolol Inderal How It Works Beta-blockers help slow the heart rate by blocking the effect of the hormone adrenaline. This reduces the number of electrical impulses that pass through the atrioventricular (AV) node to the lower heart chambers (ventricles). Why It Is Used Beta-blockers are used to help control the heart rate. They are also used to treat high blood pressure and angina (chest pain). How Well It Works Beta-blockers are very effective at slowing the heart rate. Some of the medications have also been shown to be helpful for people with coronary artery disease or heart failure. Side Effects Side effects of beta-blockers include: Fatigue. Dizziness. Inability to get or maintain an erection (impotence). Cold arms, hands, legs, or feet due to poor blood flow to these areas. Lack of awareness of severe low blood sugar levels in people with diabetes who take insulin or oral hypoglycemics. Depression. Slow heart rate. Shortness of breath. Wheezing in people with asthma.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.) What To Think About Beta-blockers can sometimes slow down the heart rate too much. They can also worsen longterm (chronic) heart failure. Close monitoring during treatment is important, although most people do not have serious side effects from this medication. Some of these medications may cause symptoms to worsen in people who have asthma, chronic obstructive pulmonary disease (COPD), and some types of heart failure

Calcium channel blockers for fast heart rates

Examples diltiazem Cardizem Cartia Dilacor Tiazac verapamil Calan Covera Isoptin Verelan How It Works Certain calcium channel blockers help slow the heart rate by reducing the number of electrical impulses that pass through the atrioventricular (AV) node into the lower heart chambers (ventricles). Why It Is Used Verapamil and diltiazem are used to treat people with irregular or fast heartbeats. They can also be used to treat chest pain (angina) caused by hardening of the arteries in the heart (coronary artery disease) and high blood pressure. How Well It Works Certain calcium channel blockers (verapamil and diltiazem) can help slow a rapid heart rate. Other calcium channel blockers have little or no effect on heart rate or may actually increase it. Side Effects Side effects vary, depending on the individual drug, but they may include: Slow heart rate. Flushing, a pounding sensation in the head, dizziness, and headache. Constipation. Leg swelling. Decreased blood pressure and worsening heart failure. Tingling sensations in the arms or legs. Weakness.

Verapamil and diltiazem may also cause a skin rash. See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.) What To Think About Verapamil and diltiazem can sometimes trigger or worsen heart failure. Calcium channel blockers and beta-blockers are usually the first medications used to control heart rate. Digoxin may be used if calcium channel blockers and beta-blockers are not effective, a person cannot tolerate these medications because of low blood pressure, or underlying heart disease requires their use. When beta-blockers and verapamil and/or digoxin are used together, they may further slow your heart rate and should be used with caution.

Digoxin for fast heart rates

Examples digitoxin Crystodigin digoxin Lanoxicaps Lanoxin How It Works Digoxin helps slow the heart rate by reducing the number of electrical impulses that pass through (but do not originate in) the atrioventricular (AV) node into the lower heart chambers (ventricles). Digoxin can also strengthen ventricular contractions so that the heart is able to pump more blood with each beat. Why It Is Used Digoxin slows heart rate and strengthens heart contractions in people who have a fast heart rate. Digoxin can also be used to treat heart failure. How Well It Works Digoxin may improve symptoms by slowing the heart rate and strengthening the heart contractions in people who have heart failure. Side Effects High doses may cause digoxin poisoning. Symptoms of digoxin poisoning include: Confusion. Nausea. Loss of appetite. Visual disturbances. Slow (bradycardia) or rapid (tachycardia) heart rates.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.) What To Think About Regular blood tests may be needed while taking digoxin to monitor levels of the drug to prevent poisoning. Digoxin does not lower blood pressure as do other drugs used to treat fast heart rates. Digoxin does not prevent recurrences of fast heart rates. Beta-blockers or calcium channel blockers work better to control heart rate during exercise. Smaller doses of digoxin must be used in people who have kidney problems. Other medications may affect the level of digoxin in the blood.

Antiarrhythmic medications for fast heart rates

Examples amiodarone Cordarone Pacerone disopyramide Norpace dofetilide Tikosyn flecainide Tambocor procainamide Procanbid Promine Pronestyl propafenone Rythmol quinidine Quinaglute Quinidex Extentabs sotalol Betapace How It Works Antiarrhythmic medications work in various ways to return the heart to its normal rhythm. These medications stabilize heart rhythm by decreasing abnormal firing of the heart's electrical system that causes the heart to beat too fast or by slowing the electrical conduction through abnormal

pathways. Some antiarrhythmics also slow the heart rate by reducing the number of impulses that can pass through the atrioventricular (AV) node (amiodarone, sotalol). Why It Is Used Antiarrhythmic medications are used to change an abnormal heart rhythm to a regular rhythm and to prevent an abnormal heart rhythm. How Well It Works Antiarrhythmic medications can effectively control or prevent abnormal heart rhythms. There are many different types of antiarrhythmic medications. You may need to try different medications to see which one works best for you. Side Effects Some antiarrhythmic medications may increase the risk of developing a more rapid, abnormal heart rate problem (ventricular tachycardia or ventricular fibrillation), especially for those people with abnormal anatomy of the heart. Close monitoring while taking these medications is important. Side effects of antiarrhythmics include: Chest pain. Slow heartbeat. Palpitations. Fatigue. Headache. Dizziness. Nausea and vomiting. Unusual taste in the mouth. Stomach pain. Constipation or diarrhea. Difficulty breathing. Rash. Vision problems. Urinary retention in men. Blue tinge to the skin (with amiodarone).

The FDA recently issued warnings about the medication amiodarone (Cordarone). People taking this medication should be aware that it may cause serious side effects that can lead to death, including lung damage, liver damage, and more severe heartbeat problems. Amiodarone is typically used for people who have severe symptoms when other medications have failed. The FDA recommends that you talk to your doctor if you have any side effects or any concerns about taking amiodarone.1 See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.) What To Think About You should learn to take your pulse if you are taking an antiarrhythmic medication. Notify your doctor if your heart rhythm becomes too slow (less than 50 beats per minute) or irregular while you are taking an antiarrhythmic medication

http://www.webmd.com/heart-disease/tc/Supraventricular-Tachycardia-Medications