Diagnosis and management of supraventricular tachycardia

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.