Supraventricular Tachycardia: Drug Therapy

Therapeutic target

  • Initially, the achievement of a heart rate of less than 110/min.
  • Termination of the cardiac arrhythmia

Therapy recommendations

  • Acute treatment:
    • Hemodynamically stable:
      • vagal maneuvers
        • Valsalva squeeze test (synonym: Valsalva maneuver; cardioversion rate: 17-43%):
          • Body position: backrest placed flat and both legs of the patient lifted about 45 degrees by the assistant in an extended position (increases venous return of blood)Currently, a semi-upright position, a duration of 15 seconds, and at the end immediate lying down and lifting of the legs by an assistant is recommended. Conversion after 1 minute is 43% of patients.
          • Forced exhalation against the closed mouth and nostrils with simultaneous use of the abdominal pressAlternatively, blow so hard into a 10 ml syringe that the plunger begins to move.
          • Duration: 15 sec!

          Caveat (Warning!): patients with pulmonary hypertension should avoid a Valsalva squeeze (synonym: Valsalva maneuver) because of the risk of orthostatic hypotension (drop in blood pressure associated with standing) and syncope (brief loss of consciousness).

        • Drinking ice water
        • Unilateral pressure on the carotid sinus (carotid massage).
      • If necessary, antiarrhythmic drugs after 12-lead ECG diagnosis; drug of first choice: adenosine, i.v.; for more see below AV nodal reentry tachycardia.
    • Hemodynamically unstable* → electrical cardioversion (therapeutic procedure of cardiology to restore sinus rhythm (regular heart rhythm) in an existing cardiac arrhythmia), if necessary later catheter ablation.

* Hemodynamically unstable

  • Systolic blood pressure < 90 mmHg
  • Impaired consciousness
  • Chest pain
  • Heart failure (cardiac insufficiency)

Other notes