[Current treatment of supraventricular tachycardia: drug therapy]

Recurrent supraventricular arrhythmias are associated with palpitations, weakness, syncopes, etc. Pharmacological treatment with antiarrhythmic agents aims to interrupt the tachyarrhythmia episodes (acute therapy) and to stabilize sinus rhythm thereafter (chronic therapy). Due to the newer curative options (transvenous ablation), the segment for the pharmacological therapy is shrinking. Treatment with antiarrhythmic agents is still indicated, if the recurrence of tachycardia episodes can be sufficiently controlled by a well-tolerated antiarrhythmic regimen. In the cohort of atrial fibrillation, total mortality and mortality from cardiovascular causes were increased under the influence of quinidine. The risk must, therefore, be weighed against the anticipated benefit from as well as the likelihood of arrhythmia suppression, before treating a patient with class I antiarrhythmic drugs. In some cases, reduction of ventricular rate by calcium antagonists will be the better choice. In case of recurrent atrial fibrillation without or with minimal structural abnormalities, propafenone or flecainide are recommended. Sotalol, and in rare cases amiodarone, will be applied in coronary artery disease. Atrial fibrillation of recent onset may be interrupted by bolus injection of ajmaline, propafenone, or flecainide. In case of impaired cardiac function, intravenous amiodarone can be applied safely. In summary, the scientific basis for the treatment of supraventricular tachycardias has been strengthened by clinical trials. Careful evaluation of the individual patient is warranted prior to institution of the pharmacological treatment.