Paroxysmal Supraventricular Tachycardia Treatment: Evaluating the Evidence for Established and Newly Approved Options

Paroxysmal supraventricular tachycardia (PSVT) imposes a substantial burden on patients and health care systems. Despite available treatments, a notable gap exists between evidence-based medicine and real-world practice. Acute treatments such as intravenous adenosine require administration in clinical settings. At-home vagal maneuvers are simple and cost-effective yet are often less effective than those administered by health care providers. The pill-in-the-pocket strategy, defined as patient-administered beta blocker or calcium-channel blocker therapy, is limited by delayed onset of action and risk of side-effects, and is not supported by robust clinical evidence or guidelines. Approved in late 2025, etripamil nasal spray represents a promising advancement that may provide a safe, effective, self-administered therapy used outside of health care setting. In this review, we examine the existing evidence and practical limitations of current PSVT treatments and discuss the potential clinical implications of etripamil as a novel, rapidly acting, self-administered therapy for the termination of acute symptomatic PSVT.