In stable SVT, which of the following is an acceptable alternative to adenosine for rhythm control?

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Multiple Choice

In stable SVT, which of the following is an acceptable alternative to adenosine for rhythm control?

When a stable SVT is AV-nodal dependent, slowing conduction through the AV node can interrupt the reentrant circuit and restore normal rhythm. Adenosine does this by briefly blocking AV nodal conduction, but if adenosine isn’t suitable or doesn’t work, a non-dihydropyridine calcium channel blocker—such as diltiazem or verapamil—is a well-established alternative. These drugs quickly slow AV nodal conduction and increase refractoriness, which can terminate the tachycardia and convert to sinus rhythm. They’re given IV for rapid effect and are commonly used in the emergency/paramedic setting for stable narrow-complex SVT. Use with caution because they can cause hypotension and bradycardia, and they’re not appropriate in all patients (for example, in significant LV dysfunction or certain pre-excitation syndromes). Magnesium sulfate isn’t a direct rhythm-control option for stable SVT, and while beta blockers can be used in some cases, non-dihydropyridine calcium channel blockers are the classic alternative to adenosine in this scenario.

When a stable SVT is AV-nodal dependent, slowing conduction through the AV node can interrupt the reentrant circuit and restore normal rhythm. Adenosine does this by briefly blocking AV nodal conduction, but if adenosine isn’t suitable or doesn’t work, a non-dihydropyridine calcium channel blocker—such as diltiazem or verapamil—is a well-established alternative. These drugs quickly slow AV nodal conduction and increase refractoriness, which can terminate the tachycardia and convert to sinus rhythm. They’re given IV for rapid effect and are commonly used in the emergency/paramedic setting for stable narrow-complex SVT.

Use with caution because they can cause hypotension and bradycardia, and they’re not appropriate in all patients (for example, in significant LV dysfunction or certain pre-excitation syndromes). Magnesium sulfate isn’t a direct rhythm-control option for stable SVT, and while beta blockers can be used in some cases, non-dihydropyridine calcium channel blockers are the classic alternative to adenosine in this scenario.

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