Verapamil for acute management of paroxysmal supraventricular tachycardia
Verapamil can be considered for the acute management of paroxysmal supraventricular tachycardia if vagal manoeuvres and adenosine do not restore sinus rhythmBrugada 2020.
Do not give verapamil to a patient with a wide-complex tachycardia unless it is known to be of supraventricular origin. A QRS complex wider than 0.12 seconds may represent supraventricular tachycardia with a rate-related or pre-existing bundle branch block; however, always consider ventricular tachycardia. If the QRS complex is wider than 0.14 seconds, ventricular tachycardia is more likely than paroxysmal supraventricular tachycardia.
A suitable regimen of verapamil to restore sinus rhythm in patients with paroxysmal supraventricular tachycardia is:
verapamil 5 to 10 mg intravenously over 2 minutes. If this is ineffective but well tolerated, give a further dose of 5 to 10 mg after 30 minutesPage 2016Brugada, 2020. verapamil verapamil verapamil
Verapamil is generally safe; however, it can occasionally cause profound depression of heart rate or contractility, particularly in patients who have pre-existing myocardial disease or those taking beta blockers.