Medications for supraventricular tachycardia
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Overview of Medications for Supraventricular Tachycardia (SVT) Management
Supraventricular tachycardia (SVT) is a group of arrhythmias originating above the ventricles, commonly managed with medications, especially when catheter ablation is not suitable. The choice of medication depends on patient age, SVT mechanism, and clinical context, with both acute and chronic management strategies available 145.
Acute Pharmacological Treatment for SVT
Adenosine and Calcium Channel Blockers in Adults
Adenosine is widely recognized as a first-line drug for acute SVT termination due to its rapid onset and short duration of action. It is highly effective, with a mean success rate of 93% in converting SVT to sinus rhythm, and is generally well-tolerated, causing only brief, mild side effects such as chest discomfort and flushing . Comparative studies show adenosine and calcium channel blockers (like verapamil) are similarly effective, but adenosine acts faster and is less likely to cause hypotension, though it may cause more minor side effects 26. Verapamil is an alternative, especially when adenosine is contraindicated, but carries a risk of hypotension .
Pediatric and Infant Acute Management
In infants and children, adenosine is also used for acute SVT, but other medications such as propranolol, esmolol, procainamide, and digoxin are considered, especially when adenosine is ineffective or contraindicated 45. The choice often depends on the presence of preexcitation (e.g., Wolff-Parkinson-White syndrome), with propranolol and procainamide favored in such cases .
Chronic and Maintenance Therapy for SVT
Beta Blockers and Digoxin
For long-term prevention of SVT recurrence, beta blockers (especially propranolol) and digoxin are commonly used in infants and children. Propranolol is the most frequently chosen first-line agent, with digoxin used less often, particularly in cases with preexcitation due to safety concerns 35910. Both drugs are generally effective, and no significant difference in efficacy has been observed between them in large cohorts .
Other Antiarrhythmic Agents
Other medications used for chronic SVT control include amiodarone, flecainide, sotalol, and propafenone. Amiodarone and flecainide are often reserved for cases where first-line agents are ineffective or not tolerated 579. Combination therapy may be required in some infants, especially those with persistent or recurrent SVT, and is more common in contemporary practice 379.
Duration and Safety of Maintenance Therapy
Recent studies suggest that shortening the duration of antiarrhythmic therapy in infants from 12 to 6 months does not increase the risk of SVT recurrence, especially if the arrhythmia is controlled with a single medication . Most antiarrhythmic medications are well-tolerated in infants and children, with low rates of adverse events and rare serious complications 3910.
Emerging and Experimental Therapies
Advances in understanding the molecular mechanisms of SVT have led to the development of new drugs targeting specific pathways, such as inflammation and structural remodeling, beyond traditional ion channel blockers. These novel agents offer hope for more personalized and effective SVT management, especially for patients who are not candidates for ablation or have refractory arrhythmias .
Conclusion
Adenosine remains the preferred acute therapy for SVT in most patients due to its efficacy and safety profile, while beta blockers (especially propranolol) and digoxin are commonly used for chronic management in infants and children. Other antiarrhythmic agents and combination therapies are considered for refractory cases. The choice of medication should be individualized based on patient characteristics, SVT mechanism, and risk factors. Ongoing research into novel pharmacological targets may further improve SVT management in the future 12345679+1 MORE.
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