eMedicine Specialties > Cardiology > Arrhythmias

Paroxysmal Supraventricular Tachycardia: Follow-up

Author: Monika Gugneja, MD, Consulting Staff, Department of Emergency Medicine, William Beaumont Hospital
Coauthor(s): Phillip L Kraft, MD, Director, Interventional Cardiology and Cardiac Catheterization Laboratory, William Beaumont Hospital
Contributor Information and Disclosures

Updated: Aug 12, 2009

Follow-up

Further Inpatient Care

Patients who require cardioversion, are unstable, and have comorbid illnesses should be admitted to the hospital. Patients who are young, healthy, and asymptomatic may be discharged and advised to have a follow-up examination with their primary physician or cardiologist. If the patient is having more frequent episodes of paroxysmal supraventricular tachycardia and medical therapy is not successful or desired, then radiofrequency ablation should be proposed.

Further Outpatient Care

Patients treated medically should be monitored regularly. Patients cured with radiofrequency catheter ablation are typically seen once in a follow-up examination following the procedure, then as needed for recurrent symptoms.

Transfer

Transfer to a center with radiofrequency catheter ablation is reasonable if this therapy is planned. Alternatively, patients can be discharged home and scheduled for outpatient procedures. Exceptions include patients with syncope, profound symptoms, or preexcited atrial fibrillation or atrial flutter.

Complications

  • Rare complications of paroxysmal supraventricular tachycardia include myocardial infarction, congestive heart failure, syncope, and sudden death.
  • Potential complications of radiofrequency catheter ablation include hematoma, bleeding, infection, pseudoaneurysm, myocardial infarction, cardiac preformation, heart block that requires a pacemaker, thromboembolic complications, stroke, need for emergency surgery, radiation burn, increased risk of malignancy, and death.

Prognosis

Patients with symptomatic Wolff-Parkinson-White syndrome have a small risk of sudden death. Otherwise, prognosis is dependent on any underlying structural heart disease. Patients with paroxysmal supraventricular tachycardia in the setting of a structurally normal heart have an excellent prognosis.

Patient Education

For excellent patient education resources, visit eMedicine's Heart Center. Also, see eMedicine's patient education articles Supraventricular Tachycardia, Atrial Fibrillation, Atrial Flutter, and Heart Rhythm Disorders.

Miscellaneous

Medicolegal Pitfalls

  • Patients with symptomatic Wolff-Parkinson-White syndrome should be told of the potential for cardiac arrest. In general, these patients should not be treated longitudinally with calcium channel blockers or digoxin unless the pathway is known to be of low risk (long anterograde refractory period). This is because of the potential for more rapid ventricular rates should atrial fibrillation or atrial flutter occur.
  • Patients with preexcited atrial fibrillation should not be treated with intravenous AV nodal blocking agents such as adenosine, beta-blockers, calcium channel blockers, and digoxin. Rather, if the patient is hemodynamically stable, intravenous procainamide should be administered. If the patient is unstable, direct current cardioversion should be performed.

Special Concerns

Pediatric patients should be referred to a pediatric electrophysiologist.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author James V Talano, MD to the development and writing of this article.



More on Paroxysmal Supraventricular Tachycardia

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Treatment & Medication: Paroxysmal Supraventricular Tachycardia
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References
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Further Reading

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Keywords

paroxysmal supraventricular tachycardia, PSVT, supraventricular tachycardia, SVT, multifocal atrial tachycardia, MAT, tachyarrhythmia, atrial fibrillation, AF, conduction pathway disturbance, conduction pathway abnormality, conduction pathway anomaly, dysrhythmia, heart condition, heart rhythm problem, atrial tachyarrhythmia, atrioventricular tachyarrhythmia, AV tachyarrhythmia, sinus tachycardia, inappropriate sinus tachycardia, IST, sinusnodal reentranttachycardia, SNRT, atrial tachycardia, atrial flutter, AV tachyarrhythmias, AV nodal reentrant tachycardia, atrioventricular nodal reentrant tachycardia, AVNRT, atrioventricular reentrant tachycardia, AV reentrant tachycardia, AVRT, junctional ectopic tachycardia, JET, nonparoxysmal junctional tachycardia, NPJT, heartfailure, pulmonary edema, myocardial ischemia, myocardial infarction, syncope, sudden death, tachycardia-induced cardiomyopathy, WPW syndrome

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Contributor Information and Disclosures

Author

Monika Gugneja, MD, Consulting Staff, Department of Emergency Medicine, William Beaumont Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Phillip L Kraft, MD, Director, Interventional Cardiology and Cardiac Catheterization Laboratory, William Beaumont Hospital
Phillip L Kraft, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Alan D Forker, MD, Professor of Medicine, Program Director of Cardiovascular Fellowship, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research Center, MidAmerica Heart Institute of St Luke's Hospital
Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hypertension, and Phi Beta Kappa
Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee with no personal profit; Speakers Bureau Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Brian Olshansky, MD, Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine
Brian Olshansky, MD is a member of the following medical societies: American Autonomic Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Sports Medicine, American Federation for Clinical Research, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, and New York Academy of Sciences
Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting; Reliant Grant/research funds Other; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Michael E Zevitz, MD, Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice
Michael E Zevitz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

 
 
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