1.Acute attack period
Appropriate treatment should be made according to the patient’s original heart disease, previous episodes and tolerance level of tachycardia.
(1) Excitation of the vagus nerve to terminate the attack
For those without organic heart disease and no obvious heart failure, this method can be used to stimulate the pharynx with tongue depressor or fingers to stimulate the pharynx to produce nausea and vomiting; also allow the patient to hold his breath after deep inspiration (Valsalva method); if ineffective, try compression of the carotid sinus method (patient in supine position, right side first, 5-10 seconds each time, do not massage bilaterally), diving reflex method (submerge the face in ice water).
(2) Drug therapy
①Adenosine and adenosine triphosphate
Advantages: these two drugs have a very short half-life, fast onset of action, the effect disappears within 1 to 2 minutes, no negative inotropic force, can be used for heart failure and hypotensive patients. Side effects: Side effects such as flushing of the face, headache, nausea, vomiting, cough, chest tightness, chest pressure and chest pain are often observed. Serious side effects include sinus arrest and atrioventricular block, so it is not indicated in patients with sinus node and atrioventricular node conduction dysfunction. It is contraindicated in patients with asthma and used with caution in patients with severe coronary artery disease.
②Calcium channel blockers
Verapamil (Isoptin); diltiazem. Contraindications: severe congestive heart failure; severe hypotension or cardiogenic shock; sick sinus syndrome; second or third degree atrioventricular block; patients with atrial flutter or atrial fibrillation combined with atrioventricular bypass channels; patients with beta-blockers or digitalis toxicity; ventricular tachycardia (except left ventricular idiopathic ventricular tachycardia); patients with known hypersensitivity to verapamil.
③Propafenone (cardioplegia)
Side effects: Aggravation of intraventricular conduction disturbances, negative inotropic effects, induction or exacerbation of heart failure, resulting in a state of low cardiac output. Therefore, myocardial ischemia, cardiac insufficiency and intraventricular conduction disorders are relatively contraindicated or used with caution.
Digitalis
This drug is contraindicated in cases of severe disease, episodes lasting more than 24 hours and manifestations of heart failure, and supraventricular tachycardia caused by digitalis toxicity. Use with caution in cases of hypokalemia, myocarditis, paroxysmal supraventricular tachycardia with atrioventricular block or renal hypofunction. Currently, digitalis is rarely used to terminate paroxysmal supraventricular tachycardia.
⑤ β-blockers
The short-acting beta-blocker Esmolol is used. Contraindications: bronchial asthma or history of bronchial asthma; severe chronic obstructive pulmonary disease; sinus bradycardia; atrioventricular block of degree II or higher; refractory cardiac insufficiency; cardiogenic shock; hypersensitivity to this product. (6) Amiodarone
Not routinely used clinically to terminate paroxysmal supraventricular tachycardia. Side effects: abnormal thyroid function, pulmonary fibrosis, corneal hyperpigmentation, skin photoallergic reactions, etc.
(3) Tachycardia suppression
Tachycardia is terminated by transesophageal pacing in patients for whom drug therapy is ineffective and electrical cardioversion is contraindicated.
(4) Synchronized direct current electrical resuscitation
When patients present with angina pectoris, hypotension, and congestive heart failure manifestations, they should be treated immediately with electrical cardioversion.
2.Prevention of recurrence
(1)Radiofrequency ablation with cardiac catheterization (RFCA) is a minimally invasive radical treatment method with mature procedure and low risk, and is the first-line treatment for paroxysmal supraventricular tachycardia.
(2) Effective drug maintenance therapy, whether patients need to be given long-term drugs to prevent tachycardia depends on the frequency of episodes, the severity of the episodes, and the availability of cardiac catheterization for radiofrequency ablation. Digitalis preparations (digoxin); long-acting calcium channel blockers (extended-release verapamil, long-acting diltiazem): long-acting beta-blockers (bisoprolol, metoprolol).