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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
  • Hyperthyroidism
  • Stimulant use (including caffeine)
  • Previous myocardial infarction, mitral valve prolapse, rheumatic heart disease, pericarditis, pneumonia, chronic lung disease, alcohol intoxication
  • 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 reentry.

  • Prevalence: ~2 cases per 1000 persons in United States.
  • Incidence: 35 cases per 100,000 person-years.

Signs and Symptoms

  • Many patients asymptomatic or have only occasional minor palpitations or irregular pulse.
  • Patients may experience:
    • Choking or pressure sensation
    • Dizziness
    • Lightheadedness
    • Shortness of breath
    • Syncope
    • 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 and Diagnosis

  • Electrocardiogram (ECG) shows regular rhythm with rate between 140–240 beats/min.

Laboratory Tests

  • May be performed if underlying causes suspected (e.g., hyperthyroidism, digoxin toxicity).

Differential Diagnosis

  • 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 fail.
  • Drug selection based on QRS complex (Figure 1).
    • Directly or indirectly increase vagal tone to AV node, with digoxin.
    • Depress conduction through slow, calcium-dependent tissue:
      • Adenosine
      • β-blockers
      • Nondihydropyridine calcium channel blockers
    • Depress conduction through fast, sodium-dependent tissue
      • Quinidine
      • Procainamide
      • Disopyramide
      • Flecainide
  • 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.

Figure 1.

Algorithm for 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. 8th ed. ...

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