Verapamil in the treatment of PSVT

Verapamil is considered by many investigators to be the drug of choice for the acute management of uncomplicated PSVT. Several clinical investigators have demonstrated termination of PSVT in more than 90% of their patients within minutes following IV drug administration. The incidence of reported severe adverse reactions has been less than 1%. PSVT may be complicated by underlying heart disease, or by antegrade accessory pathway conduction in individuals with pre-excitation syndrome. Such conditions, or the prior use of beta-blocking agents, may contraindicate the use of verapamil. However, the history of recent myocardial ischemia or the prior use of digitalis does not appear to contraindicate verapamil therapy. Guidelines for the emergency management of the patient in PSVT are presented.