Overview of paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardia is common and results in a regular, rapid heartbeat; see Management of stable acute narrow-complex tachyarrhythmia for management of stable acute narrow-complex tachyarrhythmias.

Most cases of paroxysmal supraventricular tachycardia are not considered a medical emergency. Symptoms may include palpitation, chest discomfort, breathlessness and fatigue; however, some patients may be asymptomatic and paroxysmal supraventricular tachycardia is detected incidentally(Brugada 2020). For detail on the initial evaluation of patients with supraventricular tachycardia, see Table 7 in the European Society of Cardiology guidelines for the management of patients with supraventricular tachycardia.

Acute management of paroxysmal supraventricular tachycardia is with vagal manoeuvres initially. If these manoeuvres do not restore sinus rhythm, drug therapy with adenosine, verapamil or metoprolol tartrate (with close blood pressure monitoring) restores sinus rhythm in most patients. If vagal manoeuvres and drug therapy are ineffective, direct current (DC) cardioversion, intravenous amiodarone or overdrive pacing may be required.

Some patients require catheter ablation or drug therapy to prevent further episodes of paroxysmal supraventricular tachycardia.