Paroxysmal supraventricular (atrial) tachycardia is a regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in heart tissue other than that in the ventricles.

• Most people have uncomfortable palpitations, shortness of breath, and chest pain.
• Episodes can often be stopped by maneuvers that stimulate the vagus nerve, which slows the heart rate.
• Sometimes, people are given drugs to stop the episode.

Paroxysmal supraventricular tachycardia is most common among young people and is more unpleasant than dangerous. It may occur during vigorous exercise.

Paroxysmal supraventricular tachycardia may be triggered by a premature heartbeat that repeatedly activates the heart at a fast rate. This repeated, rapid activation may be caused by several abnormalities. There may be two electrical pathways in the atrioventricular node (an arrhythmia called atrioventricular nodal reentrant supraventricular tachycardia). There may be an abnormal electrical pathway between the atria and the ventricles (an arrhythmia called atrioventricular reciprocating supraventricular tachycardia). Much less commonly, the atria may generate abnormal rapid or circling impulses (an arrhythmia called true paroxysmal atrial tachycardia).

The fast heart rate tends to begin and end suddenly and may last from a few minutes to many hours. It is almost always experienced as an uncomfortable palpitation. It is often associated with other symptoms, such as weakness, light-headedness, shortness of breath, and chest pain. Usually, the heart is otherwise normal. The doctor confirms the diagnosis by doing an electrocardiogram (ECG).

ECG: Paroxysmal Supraventricular Tachycardia

Treatment

Episodes of paroxysmal supraventricular tachycardia often can be stopped by one of several maneuvers that stimulate the vagus nerve and thus decrease the heart rate. These maneuvers are usually conducted or supervised by a doctor, but people who repeatedly experience the arrhythmia often learn to do the maneuvers themselves. Maneuvers include straining as if having a difficult bowel movement, rubbing the neck just below the angle of the jaw (which stimulates a sensitive area on the carotid artery called the carotid sinus), and plunging the face into a bowl of ice-cold water. These maneuvers are most effective when they are used shortly after the arrhythmia starts.

If these maneuvers are not effective, if the arrhythmia causes severe symptoms, or if the episode lasts more than 20 minutes, people are advised to seek medical intervention to stop the episode. Doctors can usually stop an episode promptly by giving an intravenous injection of a drug, usually adenosineSome Trade Names
ADENOCARD
or verapamilSome Trade Names
CALAN ISOPTIN SR
. Rarely, drugs are ineffective, and cardioversion (delivery of an electrical shock to the heart) may be necessary.

Prevention is more difficult than treatment. When episodes are frequent or bothersome, doctors usually recommend radiofrequency ablation. For this procedure, energy that has a specific frequency is delivered through an electrode catheter inserted in the heart. This energy destroys the tissue in which paroxysmal supraventricular tachycardia originates. If radiofrequency ablation is not an option, almost any antiarrhythmic drug may be effective. Drugs commonly used include beta-blockers, digoxinSome Trade Names
LANOXIN
, diltiazemSome Trade Names
CARDIZEM DILACOR XR
, verapamilSome Trade Names
CALAN ISOPTIN SR
, propafenoneSome Trade Names
RYTHMOL
, and flecainideSome Trade Names
TAMBOCOR
.

Last full review/revision November 2012 by L. Brent Mitchell, MD