Expectant management for patients with infrequent episodes of hemodynamically stable SVT, normal left ventricular function, and a normal resting ECG. Referral to an arrhythmia specialist is indicated for patients with poorly tolerated arrhythmias.
In reality, patients with AVNRT or AVRT are often referred early for ablation before extended trials of drug therapy. While management of patients with an asymptomatic WPW pattern on ECG is controversial, guidelines recommend referral of these patients to an arrhythmia specialist for further evaluation.
Treatment of PSVT in a patient is dependent on the type of rhythm present on the electrocardiogram and the patient's hemodynamic stability. Patients presenting with hypotension, shortness of breath, chest pain, shock, or altered mental status are considered hemodynamically unstable, and their electrocardiogram evaluation must be done to determine if they are in sinus rhythm or not.
If they are not in sinus rhythm, these patients should undergo urgent cardioversion. If they are determined to be in appropriate sinus tachycardia, then their underlying etiology must be treated. For any manifestations of cardiac ischemia, intravenous beta-blockers should be considered. If they have inappropriate sinus tachycardia on the electrocardiogram and are determined to be hemodynamically unstable, treatment with intravenous beta-blockers may be appropriate
If on the initial evaluation, a patient is to found to be hemodynamically stable, then the treatment of the patient depends on the specific PSVT present on the electrocardiogram. If the 12-lead electrocardiogram shows that the rhythm is irregular and P waves are absent, then the patient should be appropriately treated for atrial fibrillation.
If the rhythm on the electrocardiogram is irregular and flutter waves are present, then the patient should be treated for atrial flutter. If the rhythm on the electrocardiogram is irregular and multiple P wave morphologies are present, then the patient should be treated for multifocal atrial tachycardia.
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