Source: Sanoski CA, Bauman JL.
The Arrhythmias. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells
BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7972803.
Accessed June 30, 2012.
- Paroxysmal supraventricular tachycardia (PSVT) is rapid
heart rhythm originating above ventricles that occurs episodically.
- May occur in healthy individuals.
- Premature atrial or ventricular ectopic beats
- Stimulant use (including caffeine)
- Previous myocardial infarction, mitral valve prolapse, rheumatic
heart disease, pericarditis, pneumonia, chronic lung disease, alcohol
- Digoxin toxicity
- PSVT arising by reentrant mechanisms includes arrhythmias
caused by atrioventricular (AV) nodal reentry, AV reentry incorporating
an anomalous AV pathway, sinoatrial (SA) nodal reentry, and intra-atrial
- Prevalence: ~2 cases per 1000 persons in United States.
- Incidence: 35 cases per 100,000 person-years.
- Many patients asymptomatic or have only occasional minor
palpitations or irregular pulse.
- Patients may experience:
- Choking or pressure
- Shortness of breath
- Symptoms of heart failure
- Anginal chest pain
- Symptoms may be severe and even life threatening in some patients.
- Heart rate ranges from 140–240 beats/min
and is regular.
Means of Confirmation
- Electrocardiogram (ECG) shows regular rhythm with rate
between 140–240 beats/min.
- May be performed if underlying causes suspected (e.g.,
hyperthyroidism, digoxin toxicity).
- Atrial tachycardia, flutter, or fibrillation
- Atrioventricular nodal reentrant tachycardia (AVNRT)
- Sinus node dysfunction
- Ventricular tachycardia or fibrillation
- Identify and correct underlying causes.
- Terminate acute episodes and resolve symptoms.
- Prevent recurrences.
- Avoid complications from therapy.
- For mild to moderate symptoms, measures that increase
vagal tone to AV node (unilateral carotid sinus massage, Valsalva
maneuver) used initially.
- For severe symptoms, synchronized direct current cardioversion
(DCC) treatment of choice.
- Used for mild to moderate symptoms if nondrug measures
- Drug selection based on QRS complex (Figure 1).
or indirectly increase vagal tone to AV node, with digoxin.
- Depress conduction through slow, calcium-dependent tissue:
- Nondihydropyridine calcium channel blockers
- Depress conduction through fast, sodium-dependent tissue
- Adenosine a drug of first choice because its short duration
of action will not cause prolonged hemodynamic compromise in patients
with wide QRS complexes who actually have ventricular tachycardia
rather than PSVT.
treatment of acute (top portion)paroxysmal supraventricular tachycardia
and chronic prevention of recurrences (bottom
portion). Note: For empiric bridge
therapy prior to radiofrequency ablation procedures, calcium channel
blockers (or other atrioventricular [AV] nodal
blockers) should not be used if patient has AV reentry with accessory
pathway. (AAD, antiarrhythmic drugs; AF, atrial fibrillation; AP,
accessory pathway; AVN, atrioventricular nodal; AVNRT, atrioventricular
nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia;
DCC, direct-current cardioversion; ECG, electrocardiographic monitoring;
EPS, electrophysiologic studies; PRN, as needed; VT, ventricular
tachycardia.) Reprinted with permission from Wells BG, DiPiro JT,
Schwinghammer TL, et al. Pharmacotherapy Handbook. ...