Treatment of SVT

Rhythm Acute Treatment Long-term Treatment

Unstable

Acute: Cardioversion per ACLS n/a

ST

Acute: Treat underlying stressor(s) Long-term: n/a

AT

Acute: βB, CCB or adenosine; ? amiodarone Long-term: radiofrequency ablation (RFA); βB or CCB, ± class IC/III AAD

AVNRT or AVRT

Acute: Vagal maneuvers Adenosine (caution in AVRT*) CCB or βB, DCCV if other Rx fail Long-term: For AVNRT (see next section for AVRT): RFA. CCB, βB, or dig (chronic or prn) ± Class IC/III AAD (if nl heart)

NPJT

Acute: CCB, βB, amiodarone Long-term: Rx underlying dis. (eg, dig tox, ischemia)

AF

Acute: βB, CCB, digoxin, AAD Long-term: See “Atrial Fibrillation”

AFL

Acute: βB, CCB, AAD Long-term: RFA; βB or CCB ± class III AAD

MAT

Acute: CCB or βB if tolerated Long-term: Treat underlying disease. CCB or βB. AVN ablation + PPM if refractory to meds

*Avoid adenosine & nodal agents if accessory pathway + pre-excited tachycardia, see below (Circ 2014;130:e199)

• Catheter ablation: high overall success rate (AFL/AVNRT ~95%, AVRT ~90%, AF ~70%) complications: stroke, MI, bleeding, perforation, conduction block