Jordan Cardiac Society (JCS) Taskforce Congress, October 2025 Supraventricular Tachycardia (SVT) Management Protocols
Jordan Cardiac Society (JCS) Taskforce Congress, October 2025
Supraventricular Tachycardia (SVT) Management Protocols
Source: JCS Task Force 2025– EP Session, Dr. Munir Zaqqa (Interventional EP Cardiologist)
Basil Abu El Haija, MD and Munir Zaqqa, MD
Keynotes:
1. Definition
•SVT = abnormal heart rhythm > 100 bpm.
•Originates from the His bundle or above (atrial or AV nodal tissue).
2. Clinical Presentation
•Main symptom: palpitations.
•Other possible symptoms: dyspnea, fatigue, light-headedness, chest discomfort, syncope, or may be asymptomatic.
3. Initial Assessment Algorithm
1.Assess patient → Check vital signs and hemodynamic stability.
2.Obtain ECG to confirm tachycardia type.
3.If sinus rhythm: search for underlying cause (anxiety, volume depletion, PE, etc.).
4.If SVT: determine if patient is stable.
4. Unstable Patient
•Immediate cardioversion (50–200 J synchronized).
5. Stable Patient – Stepwise Treatment
1.Assess mechanism on ECG:
A regular narrow-complex tachycardia usually indicates a reentry mechanism, while an irregular pattern suggests atrial fibrillation or other non-reentrant causes (e.g., AF, MAT).
2.Regular SVT (reentry type):
•Perform Valsalva maneuver (first step).
•If not converted → Adenosine 6–18 mg rapid IV bolus with escalation.
•If still not converted → AV-nodal blocking agents (beta-blocker or non-DHP CCB).
•If ineffective → Antiarrhythmic agents (flecainide, propafenone, amiodarone) — avoid contraindications.
•Cardioversion if pharmacologic treatment fails.
3.Irregular tachycardia: manage according to specific protocol (e.g., AF or MAT).
6. Long-Term Management
a. Patient Education
•Avoid caffeine, alcohol, and stress triggers.
•Regular follow-ups for symptom control and drug side effects.
•Monitor heart rhythm and adherence to therapy.
•Watch for recurrence or complications.
b. Electrophysiologic Study & Ablation
•Recommended to avoid long-term medications and prevent recurrent hospitalizations.
•Curative success rates > 95 % for AVNRT/AVRT with low risk of complications.
c. Pharmacologic Therapy
•β-blockers (metoprolol 25–100 mg daily; bisoprolol 2.5–10 mg daily).
•Calcium-channel blockers (diltiazem 120–360 mg; verapamil 120–240 mg).
•Antiarrhythmics (flecainide, propafenone, amiodarone) — reserve for refractory cases under specialist supervision.
7. Key Take-Home Messages
•Follow a structured algorithm for SVT recognition and management.
•Early ECG confirmation and stability assessment are crucial.
•Adenosine remains the first-line acute drug for regular narrow complex tachycardia that can act as a cure and/or as a diagnostic tool. Record Rhythm strips and ECG while giving adenosine is crucial to diagnosis
•Catheter ablation is the definitive therapy for SVT.