Improving Outcomes in PSVT: Best Practices for Choosing Optimal Management Strategies

Applying Best Practices in the Diagnosis of PSVT

Transcript

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Jennifer Carlquist, PA-C:
Welcome to this educational activity from GLC. I'm Jen Carlquist, and here with me today is Brian Rose. Our discussion will focus on accurate diagnosis of paroxysmal supraventricular tachycardia, or PSVT.

We're going to start today with a case. We have a 40-year-old male who was playing baseball in the very hot sun and only had a very caffeinated beverage in the morning for breakfast. He didn't drink any water or hydrate, and he presented to the emergency department with a heart rate of 130 and a complaint of palpitations and dizziness.

So, Brian, what are your thoughts on this case? And how would you assess this patient?

Brian Rose, PA-C:
I feel like this is a case that we see far too often that gets referred to us in the outpatient clinic. So this is a young man who it sounds like doesn't have a lot of other comorbid conditions that had a very abrupt onset of his symptoms.

So first and foremost, the 12-lead EKG and his baseline laboratory studies are going to be key. That's what's going to tell you everything. We're here talking about PSVT, so I'm just going to take a gander that that's probably what this gentleman's going to have. As long as he is hemodynamically stable, we can go through the entire algorithm of how to treat him. Perhaps someone at the baseball field or EMS before he arrived, or even in the ED before cardiology is called, might have tried a vagal maneuver. We know that in less than 10% of cases, that is actually going to abort that rhythm. He very well may get adenosine and convert then. Then sometimes we can get a little bit fooled, and these patients can get adenosine, and it can slow it down and show us an underlying rhythm like atrial flutter.

So it will absolutely be key that we identify the correct rhythm because that will get us from step 1, his acute treatment, to step 2, what is going to be our long-term plan for this gentleman.

Jennifer Carlquist, PA-C:
Yeah, I think that's a great strategy, Brian. And I think that the trick here is that a lot of practitioners might just think he's dehydrated because he was in the sun and he only had a caffeinated beverage to hydrate him. And so, really, just narrowing down on, again, does that rhythm change? Is there beat-to-beat variability or not? That's often a clue, and so we don't want to get trapped by that.

And so I think the other thing is, like you mentioned, are they hemodynamically stable? And do we have some time to think about our treatment options?

So ultimately, Brian, how would you determine the treatment for him?

Brian Rose, PA-C:
So, in this gentleman, let's say we were able to convert him. He did have SVT for our sake of conversation, so this gentleman might have gotten adenosine to convert him. He's now in sinus rhythm.

So this is definitely, if you or I were getting called on a Saturday about making sure this patient is seen readily in clinic, I think it would be more than acceptable to send him out on an AV nodal blocking agent, whether it be taken on daily or pill in a pocket. We could definitely get him set up with a cardiac monitor to see if he has any recurrence of his arrhythmia. And then we'll start getting into the conversation about long-term management like ablation, and do we want to give him medications like etripamil, that if he were to have another acute episode, that that could abort those symptoms.

Jennifer Carlquist, PA-C:
Yeah, I really like that strategy. And the one thing I consistently see missed when these patients are referred to us, and that's not gotten in the ER, is getting the appropriate labs, including a TSH and free T4, because sometimes that can drive the train, so to speak, as well. So we want to make sure we capture all the necessary data so that we can make the best decisions when we see them.

So ultimately, to wrap up, this was a great discussion, Brian. Thank you for sharing your tips and tricks and pearls. And I'm really excited about the future and the landscape that's changing in how we treat PSVT. Thank you, guys, for listening.

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Overview
The management of paroxysmal supraventricular tachycardia (PSVT) remains challenging, with diagnostic delays, variability in ambulatory monitoring and triage, and inconsistent implementation of evidence-based treatment strategies contributing to fragmented care. Although catheter ablation is recommended as first-line therapy for many patients experiencing symptoms, real-world management remains variable, and many patients continue to rely on emergency department care for recurrent episodes. In this series, expert faculty review best practices for diagnosing PSVT, differentiating narrow complex tachycardias, and developing individualized management plans. The discussions also examine emerging phase 3 data supporting structured, symptom-prompted, patient-initiated outpatient treatment approaches and consider how these findings may influence future PSVT care.
Disclosure of Relevant Financial Relationships
In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative requires all faculty and planners to disclose financial relationships with ineligible companies. All relevant financial relationships have been reviewed and mitigated to ensure that the content is free from commercial bias.

The following faculty and planners have disclosed relevant financial relationships with ineligible companies in the past 24 months.

Faculty:
Jennifer Carlquist, PA-C
Physician Assistant
Wellstar Health System
Marietta, GA

Jennifer Carlquist has no relevant relationships to disclose.

Sean Pokorney, MD, MBA
Electrophysiologist
Assistant Professor of Medicine
Director, Arrhythmia Core Laboratory
Duke University
Durham, NC

Consulting Fees: Abbott, Boston Scientific, Medtronic, Milestone Pharmaceuticals, Philips
Speaker: Abbott, Medtronic, Philips, Zoll Medical
Clinical Research: Medtronic, Milestone Pharmaceuticals, Philips

Brian P. Rose, PA-C, MPH, AACC
Assistant Professor, Methodist University PA Program
Department of Cardiology
First Health of the Carolinas
Pinehurst, NC

Consulting and Speaking: Bayer, Mannkind, Milestone, Lexicon
Advisory Board: Esperion, iRhythm

Reviewers/Planners/Authors:
- Cindy Davidson has no relevant relationships to disclose.
- Wilma M. Guerra has no relevant relationships to disclose.
- Brian P. McDonough, MD, FAAFP, has no relevant relationships to disclose.
Learning Objectives
Upon completion of this activity, learners should be better able to:
- Differentiate paroxysmal supraventricular tachycardia (PSVT) from other narrow complex tachycardias, including atrial fibrillation with rapid ventricular response, using ECG characteristics and clinical presentation
- Select appropriate ambulatory monitoring strategies to confirm PSVT in patients experiencing symptoms
- Apply contemporary guideline recommendations to determine the appropriate site of care and management pathway for patients with PSVT, including timely electrophysiology referral and structured outpatient episode management
- Incorporate shared decision-making principles when discussing ablation, pharmacologic options, and long-term rhythm strategy
Target Audience
This activity has been designed to meet the educational needs of cardiologists and emergency medical professionals as well as all other physicians, physician assistants, nurse practitioners, nurses, pharmacists, and healthcare professionals involved in managing patients with PSVT.
Provider(s)/Educational Partner(s)

Global Learning Collaborative (GLC) designs and executes continuing education rooted in evidence-based medicine, clinical need, knowledge gap analysis, and careful consideration of learner feedback. Our mission is to serve as an inventive and relevant resource for clinical content and educational interventions across a broad spectrum of specialties. GLC’s methodology is founded on a commitment to continuing medical education and the innovative assessment of its effects on clinical practice. Our goal is clear—to develop and deliver the best education in the most impactful manner and to verify its results with progressive outcomes research.
Commercial Support
This activity is supported by an independent educational grant from Milestone Pharmaceuticals, Inc.
Disclaimer
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of GLC. This presentation is not intended to define an exclusive course of patient management; the participant should use his/her clinical judgment, knowledge, experience, and diagnostic skills in applying or adopting for professional use any of the information provided herein. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Links to other sites may be provided as additional sources of information.

Reproduction Prohibited
Reproduction of this material is not permitted without written permission from the copyright owner.
System Requirements
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  Microsoft Edge for Windows
- Recommended Internet Speed: 5Mbps+
Publication Dates
Release Date: 10/01/2026
Expiration Date: 10/01/2027