An approach to therapy for paroxysmal supraventricular tachycardia

A variety of options are available for managing recurrent paroxysmal supraventricular tachycardia. These options include empirical drug therapy on a trial and error basis, drug therapy based on the results of electrophysiologic testing and nonpharmacologic treatment including operative therapy, catheter ablation and antitachycardia devices. Empirical drug therapy is appropriate when the tachycardia is relatively well tolerated and the patient has access to a medical facility. Therapy guided by electrophysiologic testing is more appropriate for patients with severe symptoms during tachycardia, patients with a potential for more serious arrhythmias such as atrial fibrillation in the Wolff-Parkinson-White syndrome and in patients who have failed to respond to empirical trials of drug therapy. Electrophysiologic testing usually provides information about the precise mechanism responsible for the tachycardia and allows verification of drug efficacy. It is a strict prerequisite for operative, ablative or antitachycardia device therapy. The choice of therapy depends a great deal on local expertise, patient preference and individual considerations. Operative therapy is very successful in patients with supraventricular tachycardia associated with the Wolff-Parkinson-White syndrome and should be given high priority as an option in younger patients facing a lifelong commitment to antiarrhythmic drugs.