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Supraventricular tachyarrhythmias

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of supraventricular tachyarrhythmias are prepared by our editorial team based on guidelines from the European Society of Cardiology (ESC 2020) and the American Heart Association (AHA/HRS/ACC 2016). ...
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Diagnostic investigations

Electrophysiology study: as per ACC/AHA/HRS 2016 guidelines, conduct an electrophysiology study with the option of ablation for the diagnosis and potential treatment of patients with SVT.
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  • Electrocardiography

Medical management

Acute management: as per ESC 2020 guidelines, administer intravenous adenosine (6-18 mg bolus) for acute management of hemodynamically stable patients with narrow QRS tachycardia, if vagal maneuvers fail, in the absence of an established diagnosis.
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  • Ongoing management

Nonpharmacologic interventions

Vagal maneuvers
As per ESC 2020 guidelines:
Perform vagal maneuvers, preferably in the supine position with leg elevation, for acute management of hemodynamically stable patients with narrow QRS tachycardia in the absence of an established diagnosis.
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Perform vagal maneuvers for acute management of hemodynamically stable patients with wide QRS tachycardia in the absence of an established diagnosis.
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Therapeutic procedures

Synchronized electrical cardioversion
As per ESC 2020 guidelines:
Perform synchronized direct current cardioversion for acute management of hemodynamically unstable patients with either narrow or wide QRS tachycardia in the absence of an established diagnosis.
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Perform synchronized direct current cardioversion for acute management of hemodynamically stable patients with either narrow or wide QRS tachycardia, if medical therapy fails to convert or control the tachycardia, in the absence of an established diagnosis.
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Specific circumstances

Patients with congenital heart disease, acute management: as per ESC 2020 guidelines, perform vagal maneuvers, preferably in the supine position with leg elevation, for acute management of hemodynamically stable adult patients with SVT and congenital heart disease.
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  • Patients with congenital heart disease (ongoing management)

  • Patients with tachycardiomyopathy

  • Pregnant patients (acute management)

  • Pregnant patients (ongoing management)

  • Older patients

Patient education

Patient education: as per ACC/AHA/HRS 2016 guidelines, educate patients with SVT on how to perform vagal maneuvers for ongoing management of SVT.
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