Rational bases for the therapy of supraventricular tachycardias and their management

: Supraventricular arrhythmias are frequently encountered in clinical practice. Despite their common anatomical origin above the division of His' bundle into bundle branches, these arrhythmias have profoundly different electrophysiological mechanisms, clinical significances and responses to treatment. Although 12-lead surface ECG usually enables correct identification, facilitating treatment choice in the emergency room, electrophysiologic testing to determine the site of origin and the pathway of the arrhythmia may be necessary for the management of definitive treatment. Drug therapy is efficient for conversion to sinus treatment in 80-90% of patients with new onset arrhythmias. Class Ic antiarrhythmics (propafenone and flecainide) are particularly useful for atrial fibrillation, while adenosine and verapamil are the drugs of choice for reentry tachycardias. Atrial flutter is a noteworthy exception, and DC shock is often required to terminate the arrhythmia. The results of antiarrhythmic therapy for long term prevention of recurrences are often disappointing. Recent surgical and technological developments, in particular transcatheter ablation procedures, now allow definitive resolution of most reentrant arrhythmias, including preexcitation syndrome. This report discusses current concepts regarding the management of supraventricular arrhythmias.