Clinical Review

Diagnosis and management of supraventricular tachycardia

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7769 (Published 11 December 2012) Cite this as: BMJ 2012;345:e7769
  1. Zachary I Whinnett, consultant cardiologist,
  2. S M Afzal Sohaib, British Heart Foundation clinical research training fellow and cardiology specialty registrar,
  3. D Wyn Davies, consultant cardiologist
  1. 1Waller Department of Cardiology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK
  1. Correspondence to: D W Davies dwyndavies{at}aol.com
  • Accepted 12 November 2012

Summary points

  • Supraventricular tachycardia comprises a group of conditions in which atrial or atrioventricular nodal tissues are essential for sustaining the arrhythmia

  • Common symptoms include palpitations, chest pain, anxiety, light headedness, pounding in the neck, shortness of breath, and uncommonly syncope

  • They are produced either by disorders of impulse formation and/or disorders of impulse conduction

  • For patients presenting with a regular narrow complex tachycardia, initial management is usually to slow atrioventricular node conduction, using either vagal manoeuvres or adenosine

  • Drug treatment may reduce the frequency of symptoms, but complete suppression is uncommon

  • Catheter ablation, a procedure done under local anaesthesia in the cardiac catheter laboratory, is usually curative

Sources and selection criteria

As well as using our personal reference collections, we searched PubMed to identify peer reviewed original articles, meta-analyses, observational studies, and reviews, as well as searching Clinical Evidence (http://clinicalevidence.bmj.com) and the Cochrane Collaboration databases. We used the search terms supraventricular tachycardia, atrioventricular nodal re-entry tachycardia, atrioventricular re-entry tachycardia, atrial flutter, atrial tachycardia, Wolff-Parkinson-White syndrome.

We selected randomised controlled studies or meta-analyses when available; if none were available, we used observational studies and registry data.

The term supraventricular tachycardia (SVT) encompasses many tachycardias in which atrial or atrioventricular nodal tissue are essential for sustaining the arrhythmia (box 1). In practice, however, the term SVT is generally used to refer to atrioventricular nodal re-entry tachycardia (AVNRT), atrioventricular re-entry tachycardia (AVRT), and atrial tachycardia1; in this review we follow that convention. We reviewed the literature to provide an up to date summary of our understanding of the mechanism for these arrhythmias, and we describe the approach to their diagnosis and management. Atrial fibrillation has been reviewed recently2 so is not discussed in detail here. Much of the clinical evidence in this field is derived from observational and registry data, with a limited number of …

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