In The Line of Treatment: A Systematic Review of Paroxysmal Supraventricular Tachycardia.

Farrukh Ahmad,Ayat Hashim,Domonick K Gordon,Ravi S Patel,Sai Rohit Reddy,Adiona Llukmani,Dana R Haddad,Majdi Abu Sneineh

doi:10.7759/cureus.15502

Abstract

Paroxysmal supraventricular tachycardia (PSVT) is a common tachyarrhythmia, and an electrocardiogram is the best tool for making a diagnosis. If Valsalva maneuvers and carotid sinus massage do not give positive results, then the next choice is either adenosine or calcium channel blockers. At this time, adenosine is the drug of choice of treatment. Verapamil and diltiazem are the most commonly used calcium channel blockers (CCBs). This review aimed to compare the efficacy of both drugs in the treatment of PSVT.We utilized the databases PubMed Central and Medline by using keywords: "calcium channel blockers OR adenosine AND supraventricular tachycardia." In the end, we finalized 32 studies, including observational studies, literature reviews, systematic reviews/metanalysis, and randomized control trials. We included articles only in the English language and related to humans. Two authors completed the quality assessment and evaluation of bias according to specific guidelines. Only high-quality studies were included in this systematic review based on the cut-off score of seven or above. Calcium channel blockers have a longer half-life than adenosine and were previously used as the drug of choice in the treatment of PSVT. Calcium channel blockers are safe if given slowly; however, adenosine is safer and useful when an electrocardiogram is uncertain. We compared both drugs in certain aspects and found equal efficacy. Though safer, adenosine was found to have a higher cost and a higher probability of re-initiation arrhythmia compared to calcium channel blockers.

Highlights

BackgroundAccording to the Heart Rhythm Society, millions of individuals encounter unusual heartbeats at some stage in their lives
For patients presenting with Paroxysmal supraventricular tachycardia (PSVT), a 12-lead electrocardiogram (ECG) showing a narrow complex tachycardia is the basis for making the diagnosis and uncovering the arrhythmia mechanism [4]
Adenosine has a comparatively short half-life and quick mechanism of action; it is associated with a higher drug cost, unpleasant side effects, and a higher recurrence of arrhythmia

Summary

Introduction

According to the Heart Rhythm Society, millions of individuals encounter unusual heartbeats at some stage in their lives. Paroxysmal supraventricular tachycardia (PSVT) alludes to fast rhythms that start and is sustained in atrial or atrioventricular hub tissue over the bundle of His. PSVT is caused by re-entry phenomena or automaticity at or over the atrioventricular node. PSVT includes atrioventricular nodal re-entrant tachycardia (AVNRT), atrioventricular reciprocating tachycardia (AVRT), atrial tachycardia (AT), and a few more tachyarrhythmias [2]. AVNRT is the most common type of paroxysmal SVT, followed by AVRT [3]. For patients presenting with PSVT, a 12-lead electrocardiogram (ECG) showing a narrow complex tachycardia is the basis for making the diagnosis and uncovering the arrhythmia mechanism [4]. The most common tachyarrhythmia is AVNRT [5].

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