Treatment Options for Supraventricular Arrhythmias

Supraventricular arrhythmias encompass a range of heart rhythm disorders that originate above the ventricles. The treatment approach largely depends on the specific type of arrhythmia present. Among the most common forms are atrial flutter, atrial fibrillation (AFib), and paroxysmal supraventricular tachycardia (PSVT), all of which typically require medical intervention.

Managing Atrial Fibrillation and Atrial Flutter

Atrial fibrillation and atrial flutter share similar treatment strategies, which generally focus on three key areas: restoring normal heart rhythm, controlling heart rate, and preventing blood clots. Cardioversion — the process of restoring a normal heart rhythm — can be achieved through medications such as amiodarone or propafenone. In some cases, electrical cardioversion, which involves delivering a controlled electric shock, may be necessary to reset the heart's rhythm. Additionally, procedures like radiofrequency ablation have become increasingly popular for long-term rhythm control, offering a potential cure for some patients.

Rate Control and Anticoagulation Therapy

Not all cases of AFib require rhythm restoration. In certain patients, particularly those with persistent AFib, the primary goal becomes controlling the heart rate rather than restoring normal rhythm. Medications like metoprolol, bisoprolol, digoxin, or verapamil are commonly prescribed for this purpose. One of the most significant risks associated with AFib is the formation of blood clots, which can travel to the brain and cause a stroke. To mitigate this risk, anticoagulants such as warfarin or rivaroxaban are often used to prevent clot formation and reduce stroke risk.

Treating Paroxysmal Supraventricular Tachycardia

For patients experiencing acute episodes of PSVT, vagal maneuvers can often help restore normal heart rhythm. Techniques such as coughing, inducing gagging, applying pressure to the carotid sinus, or performing a Valsalva maneuver (forceful exhalation against a closed airway) may be effective in terminating an episode. When these methods aren't sufficient, medications like propafenone or amiodarone can be administered intravenously. In more severe or recurrent cases, synchronized electrical cardioversion or catheter ablation may be employed, with the latter offering the potential for a permanent cure.