Paroxysmal Supraventricular Tachycardia (PSVT)

Treatment

PSVT can occur with few or no symptoms, and may not require treatment. If symptoms occur or there are underlying cardiac disorders, treatment may be necessary.

People having an episode of PSVT can try to interrupt the episode with a Valsalva maneuver. This consists of holding the breath and straining (i.e., pushing with the abdomen as if to provoke a bowel movement) or coughing while sitting with the upper body bent forward. Splashing ice water on the face has been reported by some people as helpful.

Persons having an episode of PSVT may be offered therapy to interrupt the arrhythmia and convert it to a normal sinus rhythm. In the emergency room, a health care provider may massage the carotid arteries in the neck in an attempt to interrupt the arrhythmia. Caution -- do not try this at home! This technique can cause severe slowing of the heart rate.

Electrical cardioversion (shock) is successful in conversion of PSVT to a normal sinus rhythm in many cases. Another way to rapidly convert a PSVT is to administer intravenous medications, including adenosine and verapamil. Other medications may be used, such as esmolol, procainamide, beta-blockers, and propafenone.

Aside from treating isolated episodes of PSVT, some patients may require a long-term or definitive treatment of the PVST which is directed toward the prevention or complete erradication of further episodes or arrhythmia. Such long-term treatment includes:

• Daily medications -- such as propafenone, flecainide, moricizine, sotalol, and amiodarone.
• Radiofrequency catheter ablation -- a curative procedure introduced in the 1990's which is currently the treatment of choice for most PSVT's.
• Surgical modification of the electrical conduction pathway (the pathways in the heart that conduct the impulse to contract) -- this may be recommended in some cases when other heart surgery for other reasons is also indicated.
• Pacemakers -- very occasionally used in children with PSVT which hasn't responded to any other treatment. The pacemaker is designed to interrupt (override) the tachycardia.