Peds SVT

For refractory or recurrent pediatric SVT, procainamide has been shown to be more effective than Amiodarone.

 Enhance the valsalva to (actually) terminate SVT

My initial treatment for stable SVT is now the modified Vasalva maneuver. We don’t have a manometer to ensure a measurable 40 mm Hg Valsalva strain, but a 10-ml syringe blown to just move the plunger generates similar pressures. I have the patient blow on a 10-ml syringe for 15 seconds, then lay them supine and raise their legs in the air for 15 seconds. I’ve successfully cardioverted more than one-third of my SVT patients using this technique. This intervention is free, safe, effective, does not require an intravenous, and can be taught to patients. There are very few treatments in medicine that are free, safe, and effective.

 SVT

Personally, we like calcium channel blockers for the treatment of stable SVT in patients who do not have signs of pre-excitation. Adenosine and calcium channel blockers are both commonly used in the treatment of SVT; however, practice often varies by region. Advantages to adenosine are the short half-life but this comes with a trade-off of patients experiencing terrifying feelings as they have a sinus pause. Calcium channel blockers have the advantage of not causing those side effects and may prevent recurrence, but patients may infrequently experience hypotension.

Pediatric Supraventricular Tachycardia

If vagal maneuvers fail, adenosine is considered the drug of choice as it is a short acting but quite powerful AV nodal blocking agent that interrupts the reentrant conduction pathways causing the arrhythmia. The recommended dosage in pediatrics is 0.1 mg/kg. If this is not successful, providers may reattempt with 0.2 mg/kg (max of 6mg and 12mg respectively). Other medications to consider would be amiodarone (5mg/kg over 20-60 minutes) or procainamide (15mg/kg over 30-60 minutes), but both of these medications may cause hypotension and involvement of a pediatric cardiologist prior to initiation may be advisable.

Treatment of pSVT: A Case for Calcium Channel Blockers

Rather than the traditional 0.25 mg/kg diltiazem bolus (with 0.35 mg/kg repeat dose), subjects instead received diltiazem at a rate of 2.5 mg/min for up to 20 minutes (max dose 50 mg). This approach can optimize dose, reduce potential for hypotension, and spare the patient that “impending doom” feeling often experienced with adenosine...

Treatment of Refractory SVT: Pearls and Pitfalls

For treatment of narrow-complex tachycardia, ACLS and AHA guidelines recommend the use of vagal maneuvers, followed by adenosine. However, non-dihydropyridine calcium channel blockers (verapamil and diltiazem) are equally efficacious, without the negative (albeit short-lived) side effects of adenosine. If given over 20 minutes, the risk for hypotension is low.

All About Adenosine

This fundamental building block of life will stop your heart – just long enough to be useful.

AVNRT

Stable patients with AVNRT can have a trial of vagal maneuvers followed by chemical cardioversion with adenosine or verapamil and synchronized electrical cardioversion if that fails.

Calcium channel blockers for stable SVT: A first line agent over adenosine?

CCBs by IV bolus or slow infusion are equally efficacious to adenosine in hemodynamically stable patients with SVT.

Common Types of Supraventricular Tachycardia: Diagnosis and Management

The most common types of supraventricular tachycardia are caused by a reentry phenomenon producing accelerated heart rates. Symptoms may include palpitations (including possible pulsations in the neck), chest pain, fatigue, lightheadedness or dizziness, and dyspnea. It is unusual for supraventricular tachycardia to be caused by structurally abnormal hearts. Diagnosis is often delayed because of the misdiagnosis of anxiety or panic disorder. Patient history is important in uncovering the diagnosis, whereas the physical examination may or may not be helpful.

Diagnostic challenges in supraventricular tachycardia: anticipating value of natriuretic peptides

Supraventricular tachycardia (SVT) refers to regular, narrow QRS complex, rhythms having an electrophysiologic substrate arising above the bundle of His and causing heart rates typically in excess of 150 bpm. Although atrial flutter and atrial fibrillation are the classes of SVT by definition, the mechanism is slightly different than those of typical SVTs.

Drop the Beat! – Adenosine in SVT

Let’s talk a bit about dosage. We mentioned above that guidelines recommend starting at 6 mg and moving to 12 mg for subsequent dosages. These dosages assume uninhibited action of adenosine at its receptors which, unfortunately, may not always be the case in patients. What would inhibit adenosine’s activity, I hear you ask? You’ll want to put down that Caramel Macchiato because the answer (pause for dramatic effect) … is coffee – caffeine to be exact.

EMS Protocol of the Week - Supraventricular Tachycardia (Adult)

For stable SVT, paramedics will give adenosine by Standing Order in the standard 6-12-12 strategy you all know and love in the ED. If hard rebooting the patient’s heart three times doesn’t fix the rate, OLMC will be called for additional orders.

JC The REVERT trial: Dip or doom for SVT in the Emergency Department?

SVT (supraventricular tachycardia) is something we see a lot of in Emergency Medicine. Any emergency physician will tell you exactly how satisfying it is to treat a patient with SVT. There must be close to a 100% successful cardioversion rate, one way or another, and after cardioversion patients can usually go straight home soon afterwards. It’s one of those things that gives you a warm glow and reminds you why you did Emergency Medicine in the first place.

Modified Valsalva Maneuver Better Way to Manage Supraventricular Tachycardia

“In patients with supraventricular tachycardia, a modified Valsalva manoeuvre with leg elevation and supine positioning at the end of the strain should be considered as a routine first treatment, and can be taught to patients.”

Modified Valsalva manoeuvre for supraventricular tachycardia

In patients with supraventricular tachycardia, a modified Valsalva manoeuvre with leg elevation and supine positioning at the end of the strain may be considered.

Slow down, you’re going too fast: SVT and The Modified Valsalva Maneuver

Vagal maneuvers, or vagals, as we like to call them, are the first line treatment for terminating supraventricular tachycardia (SVT) in the patient who is physiologically stable, and able to follow commands.

Standard Valsalva vs Modified Valsalva for Cardioversion of SVT?

Use of a 10 mL syringe and lying the patient supine with 90 degrees of hip flexion can be a useful treatment for SVT, with few adverse effects and no change in ED LOS, if the use of medications or electricity is not desired.

Supraventricular tachycardia: An overview of diagnosis and management

Supraventricular tachycardia (SVT) is a common cause of hospital admissions and can cause significant patient discomfort and distress. The most common SVTs include atrioventricular nodal re-entrant tachycardia, atrioventricular re-entrant tachycardia and atrial tachycardia. In many cases, the underlying mechanism can be deduced from electrocardiography during tachycardia, comparing it with sinus rhythm, and assessing the onset and offset of tachycardia.

Supraventricular Tachydysrhythmias in the Emergency Department

Diagnosing and treating supraventricular tachycardias is routine in emergency medicine, and new strategies can improve efficiency and outcomes. This review provides an overview of supraventricular tachycardias, their pathophysiology, differential diagnosis, and electrocardiographic features.

The Modified Valsalva Maneuver: Head Down, Legs Up

“Our review found MVM to be more effective than SVM in terminating SVT. This should encourage broader adoption of the MVM as a first-line vagal maneuver in subjects presenting with SVT in the emergency room.”