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 medicine 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 medicine 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 medicines, either on an as-needed basis or daily. Medicine treatment typically includes beta-blockers, calcium channel blockers, other antiarrhythmic medicines, or digoxin. In people with frequent episodes, treatment with medicines can decrease recurrences. But these medicines may 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 medicines. But this procedure has risks, including infection, bleeding, and injury to the heart. If your heart is injured during catheter ablation, you will need a pacemaker. You must balance your feelings about taking medicine for the rest of your life with having an invasive procedure. Also, catheter 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), medicines can be taken—either daily or only when the fast heartbeat 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 medicines only when you have an episode. These medicines include antiarrhythmic medicines, calcium channel blockers, and beta-blockers.
Your doctors may recommend daily doses of calcium channel blockers, beta-blockers, and/or digoxin if you have frequent episodes of AVNRT. If these medicines are not effective in stopping supraventricular tachycardia from recurring, your doctor may recommend that you take an antiarrhythmic medicine.
If you take daily medicine for AVNRT or you have significant symptoms, you may want to consider having catheter ablation.
Treatment for atrioventricular reciprocating tachycardia (AVRT)
In the case of atrioventricular reciprocating tachycardia (AVRT), you can take medicines for recurrent episodes either on an as-needed or daily basis, depending on how frequently they occur. These medicines—which include beta-blockers, calcium channel blockers, and digoxin—are often effective in stopping or preventing episodes of AVRT.
But in some people with a type of AVRT called Wolff-Parkinson-White (WPW) syndrome, digoxin and verapamil may result in extremely fast heart rates that can lead to lightheadedness, fainting (syncope), and even death. These drugs are only dangerous when given in an emergency when someone with Wolff-Parkinson-White syndrome is having atrial fibrillation.
Treatment of WPW frequently requires antiarrhythmic medicines, such as propafenone (Rythmol) or flecainide (Tambocor), 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 most of the time. There is a small risk of the arrhythmia recurring even after successful ablation of WPW. But a second session of catheter ablation is usually successful.
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| Author: | Robin Parks, MS | Last Updated: September 17, 2008 |
| Medical Review: |
Caroline S. Rhoads, MD - Internal Medicine
Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology |
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