Treatment Overview

Living with paroxysmal supraventricular tachycardia (PSVT) can feel like carrying a hidden alarm clock that goes off without warning. One moment you are sitting quietly, and the next, your heart is racing as if you have just sprinted a mile. These episodes can cause significant anxiety, lightheadedness, and a pounding sensation in the chest that makes it difficult to focus or relax. While the condition is generally not life-threatening, the unpredictability of the attacks can disrupt daily life and erode a person’s sense of security. Treatment is essential to restore a normal heart rhythm during an episode and to prevent the heart from racing in the future. 

Because PSVT involves a “short circuit” in the heart’s electrical system, treatment strategies vary based on how often episodes occur and how severe they are. Some individuals experience rare, short episodes that require no medication, while others face frequent, prolonged attacks that demand daily management. Decisions regarding therapy depend on the specific type of electrical pathway involved and the patient’s overall heart health (American Heart Association, 2024). 

Overview of treatment options for Paroxysmal Supraventricular Tachycardia 

The primary goal of treatment is to slow down the electrical signals causing the rapid heartbeat and restore a normal sinus rhythm. This can be approached in two ways: terminating an acute attack as it happens and preventing future episodes from starting. 

For many patients, the first step involves physical maneuvers, such as bearing down or coughing (vagal maneuvers), which stimulate the vagus nerve to slow the heart. If these mechanical methods fail, medications become the primary tool. Doctors use fast-acting drugs to stop an active episode in emergency settings and prescribe daily oral medications for long-term prevention. While procedures like catheter ablation offer a potential cure by destroying the abnormal tissue, medication remains a cornerstone for acute management and for patients who prefer to avoid invasive procedures. 

Medications used for Paroxysmal Supraventricular Tachycardia 

Doctors rely on specific antiarrhythmic drugs that target the electrical nodes of the heart to control the rhythm. 

Adenosine: This is the standard, extremely fast-acting IV medication used in hospitals to stop sudden PSVT. It effectively “reboots” the heart’s electrical system, terminating the tachycardia within seconds. It is not used for long-term prevention due to its rapid clearance. 

Calcium channel blockers: Verapamil or diltiazem, non-dihydropyridine calcium channel blockers, are often prescribed for both acute and long-term prevention. They effectively slow electrical conduction through the AV node. Clinical experience suggests these are often the preferred maintenance therapy for patients without structural heart disease. 

Beta-blockers: Drugs like metoprolol or atenolol are commonly used to reduce the frequency of episodes. By blocking the effects of adrenaline, they keep the resting heart rate lower and make the heart less excitable, reducing the likelihood of a “short circuit” being triggered by stress or exercise. 

Antiarrhythmics: In cases where other medications are ineffective, stronger antiarrhythmic drugs like flecainide or propafenone may be prescribed. These are typically reserved for patients with healthy hearts who have stubborn, recurrent symptoms (Mayo Clinic, 2023). 

How these medications work 

The medications used for PSVT target the electrical pathways that coordinate the heartbeat. 

Adenosine acts as a temporary roadblock at the AV node, briefly breaking the short circuit and allowing the heart’s natural pacemaker to restore a normal rhythm.  

Calcium channel blockers inhibit calcium flow into heart cells, slowing electrical conduction and relaxing blood vessels.  

Beta-blockers shield the heart from stress hormones like adrenaline by blocking their receptors, preventing heart rate spikes, and keeping the electrical system stable. 

Side effects and safety considerations 

While effective, these heart medications impact the entire cardiovascular system and require monitoring. 

Adenosine can cause a brief, intense feeling of chest tightness, flushing, or unease, but these effects resolve within a minute. 

Calcium channel blockers and beta-blockers both lower blood pressure and heart rate. Common side effects include fatigue, dizziness, or cold extremities. Verapamil may specifically cause constipation. 

Asthma patients should use beta-blockers cautiously, as they can constrict airways. Monitor your pulse and seek immediate medical advice if your heart rate drops too low or if you faint. 

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care. 

References 

  1. American Heart Association. https://www.heart.org 
  1. Mayo Clinic. https://www.mayoclinic.org 
  1. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov 
  1. MedlinePlus. https://medlineplus.gov 

Medications for Paroxysmal Supraventricular Tachycardia (PSVT)

These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Paroxysmal Supraventricular Tachycardia (PSVT).

Found 3 Approved Drugs for Paroxysmal Supraventricular Tachycardia (PSVT)

Verapamil

Brand Names
Verapamil HCI, Trandolapril, Verelan

Verapamil

Brand Names
Verapamil HCI, Trandolapril, Verelan
Form: Injection, Tablet, Capsule
Method of administration: Oral, Intravenous
FDA approval date: October 01, 1986
Classification: Angiotensin Converting Enzyme Inhibitor
Verapamil hydrochloride injection, USP is indicated for the following: Rapid conversion to sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory bypass tracts (Wolff-Parkinson-White [W-P-W] and Lown-Ganong- Levine [L-G-L] syndromes). When clinically advisable, appropriate vagal maneuvers (e.g., Valsalva maneuver) should be attempted prior to verapamil hydrochloride administration. Temporary control of rapid ventricular rate in atrial flutter or atrial fibrillation except when the atrial flutter and/or atrial fibrillation are associated with accessory bypass tracts (Wolff-Parkinson-White (W-P-W) and Lown-Ganong-Levine (L-G-L) syndromes). In controlled studies in the United States, about 60% of patients with supraventricular tachycardia converted to normal sinus rhythm within 10 minutes after intravenous verapamil hydrochloride. Uncontrolled studies reported in the world literature describe a conversion rate of about 80%. About 70% of patients with atrial flutter and/or fibrillation with a faster ventricular rate respond with a decrease in ventricular rate of at least 20%. Conversion of atrial flutter or fibrillation to sinus rhythm is uncommon (about 10%) after verapamil hydrochloride and may reflect the spontaneous conversion rate, since the conversion rate after placebo was similar. Slowing of the ventricular rate in patients with atrial fibrillation/flutter lasts 30 to 60 minutes after a single injection. Because a small fraction (<1.0%) of patients treated with verapamil hydrochloride respond with life-threatening adverse responses (rapid ventricular rate in atrial flutter/fibrillation and an accessory bypass tract, marked hypotension, or extreme bradycardia/asystole-see CONTRAINDICATIONS and WARNINGS ), the initial use of verapamil hydrochloride injection should, if possible, be in a treatment setting with monitoring and resuscitation facilities, including D.C.-cardioversion capability. As familiarity with the patient's response is gained, use in an office setting may be acceptable. Cardioversion has been used safely and effectively after verapamil hydrochloride injection.

Diltiazem

Brand Names
Matzim, Cardizem, Tiadylt, Tiazac, Cartia XT, Diltiazem HCI

Diltiazem

Brand Names
Matzim, Cardizem, Tiadylt, Tiazac, Cartia XT, Diltiazem HCI
Form: Injection, Tablet, Capsule
Method of administration: Oral, Intravenous
FDA approval date: November 05, 1992
Classification: Calcium Channel Blocker
Diltiazem Hydrochloride Extended-Release Tablet is a nondihydropyridine calcium channel blocker indicated for: treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. It can be used alone or in combination with other antihypertensives.

Propafenone

Generic Name
Propafenone

Propafenone

Generic Name
Propafenone
Form: Tablet, Capsule
Method of administration: Oral
FDA approval date: October 24, 2000
Classification: Antiarrhythmic
Propafenone hydrochloride is indicated to: prolong the time to recurrence of paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms in patients without structural heart disease. prolong the time to recurrence of paroxysmal supraventricular tachycardia (PSVT) associated with disabling symptoms in patients without structural heart disease. treat documented ventricular arrhythmias, such as sustained ventricular tachycardia that, in the judgment of the physician, are life-threatening. Initiate treatment in the hospital. Usage Considerations: The use of propafenone hydrochloride tablets in patients with permanent atrial fibrillation (AF) or in patients exclusively with atrial flutter or PSVT has not been evaluated. Do not use propafenone hydrochloride tablets to control ventricular rate during AF. Some patients with atrial flutter treated with propafenone have developed 1:1 conduction, producing an increase in ventricular rate. Concomitant treatment with drugs that increase the functional atrioventricular (AV) nodal refractory period is recommended. The use of propafenone hydrochloride tablets in patients with chronic atrial fibrillation has not been evaluated. Because of the proarrhythmic effects of propafenone hydrochloride, its use with lesser ventricular arrhythmias is not recommended, even if patients are symptomatic, and any use of the drug should be reserved for patients in whom, in the opinion of the physician, the potential benefits outweigh the risks. The effect of propafenone on mortality has not been determined. Propafenone hydrochloride is an antiarrhythmic indicated to: prolong the time to recurrence of symptomatic atrial fibrillation (AF) in patients with episodic (most likely paroxysmal or persistent) AF who do not have structural heart disease. ( 1 ) prolong the time to recurrence of paroxysmal supraventricular tachycardia (PSVT) associated with disabling symptoms in patients who do not have structural heart disease. ( 1 ) treat documented life-threatening ventricular arrhythmias. ( 1 ) Usage Considerations: Use in patients with permanent atrial fibrillation or with atrial flutter or PSVT has not been evaluated. Do not use to control ventricular rate during atrial fibrillation. ( 1 ) In patients with atrial fibrillation and atrial flutter, use propafenone hydrochloride with drugs that increase the atrioventricular nodal refractory period. ( 1 ) Because of proarrhythmic effects, use with lesser ventricular arrhythmias is not recommended, even if patients are symptomatic. ( 1 ) The effect of propafenone on mortality has not been determined. ( 1 )
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