Supraventricular tachycardia may arise:
(1) in the atrium
(2) in atrioventricular nodal tissue
(3) in both
Parameters:
(1) preexcitation in baseline ECG, syncope and/or high risk occupation
(2) first episode
(3) timing of episodes (sporadic or not)
(4) response to vagal nerve maneuver
(5) patient preferences for therapy
Therapeutic options:
(1) no treatment
(2) "pill in the pocket" (therapy only when symptomatic)
(3) prophylaxis with beta-blocker, verapamil, diltiazem, and/or digoxin
(4) electrophysiologic testing with catheter ablation
(5) prophylaxis with class IC or class III antiarrhythmic drug
Indications for no treatment:
(1) first episode with no preexcitation
(2) episode with no preexcitation that responds to vagal nerve maneuver
Indications for "pill in the pocket":
(1) first episode
(2) episode with no preexcitation that responds to vagal nerve maneuver
(3) sporadic episodes with no preexcitation lasting > 1 hour
Indications for prophylaxis with beta-blocker, verapamil, diltiazem and/or digoxin:
(1) failure of response to "pill in the pocket"
(2) other forms of SVT with no preexcitation (not first time, not sporadic lasting > 1 hour)
Indications for electrophysiologic testing and catheter ablation:
(1) preexcitation, syncope and/or high-risk occupation
(2) SVT with no preexcitation AND patient preference
(3) failure of prophylaxis with beta-blocker, verapamil, diltiazem and/or digoxin
Indications for prophylaxis with class IC or class III antiarrhythmic drug:
(1) failure of catheter ablation
(2) unable to perform catheter ablation
(3) failure of prophylaxis with beta-blocker, verapamil, diltiazem and/or digoxin AND unable to perform catheter ablation
