Advances in Antiarrhythmic Drug Therapy: Pharmacologic Management of Supraventricular Tachycardia.

Mohammed Kamareddine, Ali R Keramati

Journal: Cardiac electrophysiology clinics 2026;18(1):45-56

PMID: 41611373

Abstract

Pharmacologic management remains indispensable in supraventricular tachycardia despite ablation's curative potential. In stable patients, vagal maneuvers precede drugs; adenosine's ultrashort action makes it first-line, with intravenous calcium-channel or β-blockers and procainamide selected by QRS morphology and accessory-pathway risk. Chronic suppression relies on atrioventricular-nodal agents or class IC/III drugs selected by cardiac substrate and comorbidities, while special populations demand dose and drug modifications. Emerging self-administered therapies-particularly intranasal etripamil and selective A1 agonists-promise convenient, rapid conversion outside hospital settings. An individualized, guideline-driven strategy balancing efficacy, safety, and patient preference remains central to optimal supraventricular tachycardia care.

Address: Division of Cardiology, Department of Medicine, Lankenau Medical Center, 100 East Lancaster Avenue, Wynewood, PA 19096, USA.; Division of Cardiology, Department of Medicine, Lankenau Medical Center, Lankenau Institute of Medical Research, 100 East Lancaster Avenue, Wynewood, PA 19096, USA. Electronic address: [email protected].

DOI: 10.1016/j.ccep.2025.10.002

MeSH Terms: Humans, Anti-Arrhythmia Agents, Tachycardia, Supraventricular