Skip to Main Content

Chapter 11: Supraventricular Tachycardias

Byron K. Lee

INTRODUCTION

ESSENTIALS OF DIAGNOSIS

  • Heart rate greater than 100 bpm.

  • Rhythm is supraventricular in origin.

General Considerations

Supraventricular tachycardias (SVTs) are rapid rhythm disturbances originating from the atria or the atrioventricular (AV) node. In the absence of a bundle branch block, there is intact conduction to the ventricles via the right and left bundles leading to a narrow and normal-appearing QRS. Therefore, these arrhythmias are also often called narrow complex tachycardias. Because many of the SVTs are episodic, many clinicians also refer to this group of arrhythmias as paroxysmal SVTs. Radiofrequency ablation has become an important therapeutic option in the management of SVTs because of its ability to cure these arrhythmias safely. Table 11–1 outlines the pharmacologic therapy for SVTs.

Table 11–1.Antiarrhythmic Drugs for Supraventricular Tachycardias
View Table||Download (.pdf)
Table 11–1. Antiarrhythmic Drugs for Supraventricular Tachycardias
...
Agent Indication Intravenous Dose Oral Dose Adverse Effects Drug Interactions
Class Ia          
Quinidine AF, AFL, AVNRT, AVRT 6–10 mg/kg over 20–30 min 200–400 mg q4–6h; q8h with long-acting preparations Hypotension (especially IV), ventricular proarrhythmia, GI disturbance, thrombocytopenia

↑ Digitalis level

↑ Warfarin effect

↑ Metoprolol, propranolol, propafenone levels
Procainamide AF, AFL, AVNRT, AVRT

Bolus: 15 mg/kg given as 20 mg/min

Infusion: 2–4 mg/min

 50 mg/kg/day q3–4h; twice daily dosage with longacting preparation GI disturbance, hypotension, SLE, agranulocytosis, FUO hemolytic anemia, myasthenia gravis aggravation, ventricular proarrhythmia ↑ Procainamide level with cimetidine, quinidine, and amiodarone
Class Ic          
Flecainide AF, AFL, AT, AVNRT, AVRT N/A 50–200 mg q12h Ventricular proarrhythmia, CHF, GI disturbance, CNS (dizziness, tremor, light-headedness)

↑ Digitalis level

↑ Flecainide level with amiodarone, cimetidine, Norpace, propranolol

↓ Flecainide level with smoking
Propafenone AF, AFL, AVNRT, AVRT N/A 150–300 mg q8h or 225–425 mg bid (long-acting form) GI disturbance, CNS (dizziness), metallic taste, CHF, first-degree AVB, IVCD, positive ANA Synergism with β-blockers
Class II (IV)          
Esmolol Ventricular rate control for AF, AFL, ST, AT

Bolus: 500 mcg/kg over 1–2 min

Infusion: 50–200 mcg/kg/min

 N/A CHF, AVB, bradycardia, bronchospasm  
Propranolol Ventricular rate control for AF, AFL, ST, AT 1–5 mg at 1 mg/min 20–320 mg/day q6h, q8h, q12h, or once daily, depending on preparation CHF, AVB, bradycardia, bronchospasm  
Class III          
Sotalol AF, AFL, AVNRT, AVRT, AT N/A 80–160 mg q12h Dyspnea, fatigue, dizziness, CHF, bradycardia, ventricular proarrhythmia, bronchospasm Synergism with Ca2+ antagonists or β-blockers
Amiodarone AF, AFL, AVNRT, AVRT, AT

Bolus: 150 mg over 10 min

Infusion: 1 mg/min × 6 h, then 0.5 mg/min

 100–400 mg once daily Pulmonary toxicity, CHF, tremor, bradycardia, ↑ LFTs, corneal deposits, skin discoloration, GI intolerance, hyper-/hypothyroidism

↑ Digoxin levels

↑ Warfarin effect

↑ Quinidine, procainamide/NAPA, flecainide

↑ Phenytoin level
Ibutilide AF, AFL 1 mg bolus over 10 min; second bolus, if needed, after 10-min wait N/A Ventricular proarrhythmia, hypotension, GI disturbance

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close