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

PSVT Management: Suboptimal Care Is Too Frequent

Transcript

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Brian Rose, PA-C:
Hello, I'm Brian Rose. I'm a PA in cardiology, and I would like to talk to you about paroxysmal supraventricular tachycardia today.

Paroxysmal supraventricular tachycardia is a very common heart rhythm problem. It affects multiple patients in the United States every year. There are definite gender and ethnic disparities that exist within this heart rhythm issue. PSVT specifically is a heart rhythm that can go in excess of 150 to 200 beats per minute and typically originates above the ventricles. While PSVT is not life-threatening, its episodic nature can be anxiety-provoking and require frequent visits to the emergency room and patients to seek out a variety of care.

These episodes can stop and start abruptly. They can often be misinterpreted through their signs and symptoms as other heart rhythm issues. Patients with PSVT can have shortness of breath, palpitations, chest pain, fatigue, and even syncope. Patients often go to the emergency room as a first line of care because of the severity of their symptoms and seeking out quick resolution. Oftentimes, patients are referred to a cardiology specialist or sometimes a cardiology subspecialist known as an electrophysiologist.

There are a variety of medications that are available. Unfortunately, they do not often work. The first line is vagal maneuvers. However, this has been shown in clinical trials to not be nearly as effective as we think. Additionally, patients can be given intravenous medications, or through the IV, which additionally have a variety of effectiveness.

Another issue that arises with patients seeking care for PSVT is the wait time for cardiology and cardiac electrophysiology evaluation. These issues combined have allowed the opportunity to have a new outpatient pathway structure to be able to allow patients to get effective care for PSVT and keep them out of the emergency room. One of these such medications is utilizing an intranasal spray, which we will talk about later. Additionally, patients can go for a catheter ablation, which is performed by a cardiac electrophysiologist.

The opportunity here is for quicker recognition and the ability to have a wide range of medications to be able to treat these patients effectively. This will require collaborative efforts between primary care providers, emergency room providers, cardiologists, and cardiac electrophysiology providers as well. This will also require us to revamp the way we treat paroxysmal SVT in the outpatient setting to allow for more patients to get quicker symptomatic benefit while they are waiting for definitive care, like an ablation.

That is all the time we have. Thank you very much for joining me today.

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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
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Publication Dates
Release Date: 10/01/2026
Expiration Date: 10/01/2027