Supraventricular Tachycardia (SVT): ECG Diagnosis and Treatment

Introduction

Supraventricular tachycardia (SVT) is a rapid heart rhythm originating above the ventricles. It often leads to palpitations, dizziness, and sometimes chest discomfort. Proper diagnosis and treatment are crucial to managing this condition effectively.

ECG Diagnosis of SVT

An ECG (electrocardiogram) is the primary tool for diagnosing SVT. Key ECG characteristics include: - Narrow QRS complex (usually <120 ms, unless there is aberrant conduction) - Regular rhythm (except in atrial fibrillation or multifocal atrial tachycardia) - P-waves may be hidden within the QRS complex or appear abnormal - Rate typically between 150-250 bpm - Sudden onset and termination (paroxysmal SVT or PSVT often follows this pattern)

Treatment Approaches

The treatment of SVT depends on the patient’s condition and whether they are hemodynamically stable.

Acute Management

  1. Vagal Maneuvers: Techniques such as the Valsalva maneuver or carotid sinus massage can help terminate SVT by increasing vagal tone.
  2. Adenosine: A first-line medication for acute SVT termination. Administered as a rapid IV push, it briefly blocks conduction through the AV node.
  3. Beta-Blockers or Calcium Channel Blockers: Used if adenosine is ineffective (e.g., metoprolol, diltiazem, or verapamil).
  4. Synchronized Cardioversion: For patients who are unstable (low blood pressure, severe symptoms), electrical cardioversion is necessary.

Long-Term Management

  • Catheter Ablation: A curative approach for recurrent SVT. Radiofrequency or cryoablation targets and eliminates abnormal pathways.
  • Medications: Beta-blockers or calcium-channel blockers can help prevent recurrence in patients not undergoing ablation.
  • Lifestyle Modifications: Avoiding triggers such as caffeine, alcohol, and stress can reduce SVT episodes.

Conclusion

SVT is a treatable condition with multiple management options depending on severity and recurrence. For recurrent or symptomatic cases, catheter ablation is often the preferred approach.

Source recommendations

1. American Heart Association (AHA) Guidelines for Supraventricular Tachycardia

  1. https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/tachycardia--fast-heart-rate
  2. https://www.ahajournals.org/doi/10.1161/cir.0000000000000311
  3. https://professional.heart.org/en/science-news/-/media/028ddd505f514ea2b3a4e74bb72e3557.ashx
  4. https://pubmed.ncbi.nlm.nih.gov/26399662/
  5. https://professional.heart.org/en/science-news/guideline-for-the-management-of-adult-patients-with-supraventricular-tachycardia

2. European Society of Cardiology (ESC) Guidelines for 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://academic.oup.com/eurheartj/article-abstract/41/5/655/5556821

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