Beta Blockers for Supraventricular Tachycardia (SVT)

Introduction

Supraventricular tachycardia (SVT) is a condition characterized by an abnormally fast heart rhythm originating above the ventricles. Beta-blockers are a class of medications commonly used to manage SVT by reducing heart rate and decreasing the heart's workload.

How Beta Blockers Work in SVT

Beta-blockers work by blocking beta-adrenergic receptors, which decreases the effects of adrenaline on the heart. This leads to: - Slower heart rate (negative chronotropic effect) - Reduced force of heart contraction (negative inotropic effect) - Less electrical excitability in the heart

These effects help prevent abnormal electrical signals that trigger SVT episodes.

Common Beta Blockers Used for SVT

  • Metoprolol (selective beta-1 blocker)
  • Atenolol (selective beta-1 blocker)
  • Propranolol (non-selective beta blocker)
  • Esmolol (short-acting beta-1 blocker, usually used in acute settings)

When to Use Beta Blockers in SVT

Beta-blockers are indicated for: - Maintenance therapy to prevent recurrent SVT episodes - Acute management of SVT in stable patients - Patients with SVT and high adrenergic tone (e.g., stress-induced SVT)

Caution and Contraindications

Beta-blockers should be used with caution in patients with: - Asthma or COPD (due to bronchoconstriction risk) - Bradycardia (slow heart rate) - Hypotension (low blood pressure) - Heart failure with reduced ejection fraction (HFrEF) (selective beta-blockers like metoprolol should be preferred)

Alternative Treatments for SVT

If beta-blockers are not suitable, alternative medications include: - Calcium channel blockers (e.g., verapamil, diltiazem) - Antiarrhythmics (e.g., flecainide, amiodarone) - Catheter ablation (for recurrent or drug-resistant cases)

Conclusion

Beta-blockers are an effective treatment option for managing SVT. However, their use should be carefully individualized based on the patient’s overall condition and comorbidities.

Source recommendations

1. American Heart Association Guidelines for Arrhythmias

  1. https://www.heart.org/en/health-topics/arrhythmia
  2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
  3. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
  4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
  5. https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf

2. European Society of Cardiology Guidelines for the Management of Supraventricular Tachycardia

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Supraventricular-Tachycardia
  2. https://academic.oup.com/eurheartj/article/41/5/655/5556821
  3. https://pubmed.ncbi.nlm.nih.gov/31504425/
  4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2019/09/10/12/36/2019-ESC-Guidelines-for-Supraventricular-Tachycardia
  5. https://www.ahajournals.org/doi/10.1161/cir.0000000000000311

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