Supraventricular Tachycardia

What is supraventricular tachycardia?

Supraventricular tachycardias (SVT) are a group of abnormally fast heart rhythms. Normally, a special group of cells begin the electrical signal to start your heartbeat. These cells are in the sinoatrial (SA) node. This node is in the right atrium, the upper right chamber of your heart. The signal quickly travels down your heart’s conducting system to the ventricles, the two lower chambers of your heart. Along the way, the signal moves through the atrioventricular (AV) node, a special group of cells between your atria and your ventricles. From there, the signal travels to your left and right ventricle. As it travels, the signal triggers nearby parts of your heart to contract. This helps your heart pump in a coordinated way.

In SVT, the signal to start your heartbeat doesn’t come from the SA node the way it should. Instead, it comes from another part of the left or right atrium, or from the AV node. It is called “supraventricular” because the signal begins someplace above your ventricles. Some area outside the SA node begins to fire quickly, causing a rapid heartbeat of over 100 beats per minute. This shortens the time your ventricles have to fill. If your heartbeat is fast enough, your heart may be unable to pump enough blood forward to the rest of your body. The abnormal heartbeat may last for a few seconds to a few hours before your heart returns to its normal rhythm.

There are several types of SVTs. The most common type in adults is atrioventricular nodal reentrant tachycardia. This occurs when you have two channels through the AV node, instead of just one. The electricity can get into a looping circuit with signals going down one channel and up the other. It can occur at any age, but it most often starts in young adulthood. It is slightly more common in women.

Another common type is atrioventricular reciprocating tachycardia. In this condition, you are born with an extra electrical connection between the atrium and the ventricle (known as an accessory pathway) that can conduct electricity. This condition can enable your heart to get caught up in a looping electrical circuit. The electricity goes down the AV node and returns back to the atrium through the accessory pathway. It then goes down the AV node again. This is slightly more common in younger women and children.

Atrial tachycardia is another common type of SVT. In this case, a small group of cells in the atria begin to fire abnormally, triggering the fast heartbeat. Multifocal atrial tachycardia is a related type. In this case, multiple groups of cells in your atria fire abnormally. These types of SVT happen more often in middle-aged people. Multifocal atrial tachycardia is more common in people with heart failure or any other heart or lung diseases.

In general, SVTs are somewhat uncommon. But they are not rare. Atrial fibrillation and atrial flutter are also technically types of SVT.

What causes supraventricular tachycardia?

SVT is usually a result of faulty electrical signaling in your heart. It is commonly brought on by premature beats. Some types of SVT run in families, so genetic differences may play a role. Other types may be caused by lung problems. It can also be linked to a number of lifestyle habits or medical problems. Some of these are:

• Excess caffeine or alcohol
• Heavy smoking
• Certain medicines
• Heart attack
• Mitral valve disease

What are the symptoms of supraventricular tachycardia?

You may not have any symptoms if you have SVT. Symptoms may vary based on how long the tachycardia lasts and how fast it is. Common symptoms include:

• Chest discomfort
• Shortness of breath
• Fatigue
• Lightheadedness or dizziness
• Pulsations in the neck
• Unpleasant awareness of the heartbeat (palpitations)

Fainting, more severe chest pain, and nausea are less common symptoms. Rarely, SVT causes sudden death.

How is supraventricular tachycardia diagnosed?

Diagnosis starts with a medical history and physical exam. Your healthcare provider will also use tests to help diagnose SVT. These tests will help your provider diagnose the particular kind of SVT you have. They also help your provider check for possible underlying causes and complications. Tests might include:

• Electrocardiogram (ECG), the most important test to analyze the abnormal rhythm
• Continuous electrocardiogram, to watch your heart rhythm over a longer period
• Blood work, to test for various causes
• Chest X-ray, to check for lung problems and examine the size of your heart
• Exercise stress test, to see how your heart works during exercise
• Echocardiography, to check your heart structure and function
• Electrophysiologic study (EPS), to evaluate the electrical activity and pathways in your heart

Your primary healthcare provider might first diagnose your SVT. But he or she will likely send you to a heart doctor (cardiologist).

How is supraventricular tachycardia treated?

SVT needs short-term and long-term treatment. Options for short-term treatment include:

• Maneuvers to stop SVT
• Medicines to stop SVT, like calcium channel blockers or adenosine
• Electrocardioversion (a shock to the heart to restart a normal rhythm)

Maneuvers are usually the first treatment unless you have severe symptoms. Your healthcare provider might have you do a Valsalva maneuver (you bear down with your stomach muscles, as though you were trying to have a bowel movement). Your provider might also try massaging the carotid artery in your neck. Both of these techniques can sometimes bring you out of SVT. If they don’t, your provider might give you medicines. Electrocardioversion is usually the first treatment if you have severe symptoms or are unstable.

Long-term treatment depends on the type of SVT and the intensity of symptoms. You may not need treatment for SVT if you have only had one episode, especially if it went away with maneuvers alone. In some cases, your healthcare provider may prescribe medicines to stop SVT that you will need to take only as needed. Beta-blockers or calcium channel blockers are common choices. This may be a good option for you if you have fewer than 3 episodes of SVT per year. If your SVT is more frequent, you may need to take medicine every day. Some people may need to take several medicines to prevent episodes of SVT.

Catheter ablation is now often a suggested treatment for recurring SVT. In some cases, it may be the initial recommended treatment. Ablation can often cure SVT. The procedure involves placing a small catheter that travels up the veins from your groin into your heart. Your healthcare provider then performs a small burn or small freeze on the abnormal area of your heart. This procedure often provides a complete cure, and you may never need medicines again. Ask your healthcare provider about what treatment strategy is right for you.

How is supraventricular tachycardia managed?

Your healthcare provider might make other recommendations to manage your SVT. These might include:

• Cutting back on alcohol and caffeine
• Avoiding smoking
• Reducing stress
• Eating a heart-healthy diet

When should I call my healthcare provider?

Call your healthcare provider if you have severe symptoms like palpitations, lightheadedness, chest pain, or sudden shortness of breath. If your symptoms are increasing in severity or frequency, plan to see your healthcare provider soon.

Key points about supraventricular tachycardia

SVT is a kind of abnormal heart rhythm. Something signals part of your atria to fire much faster than it should. This results in a fast heartbeat that can last anywhere from a few seconds to several hours.

• There are several subtypes of SVT. Your treatment options may vary based on what subtype you have.
• Very rarely, SVT can cause sudden death.
• You might need a shock to the heart if you are having severe symptoms from SVT.
• Some people with SVT need to take medicines if an SVT happens. Others need to take medicine permanently. Ablation is an option for many people to cure this problem.
• Follow all of your healthcare provider’s instructions about medicine and lifestyle management.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.