Management of Supraventricular Tachycardia
Most supraventricular
tachycardias (SVTs) in
the neonate are re-entry
atrioventricular SVTs via
an accessory pathway.
Synchronized DC Shock
 Sedate first.
 Select appropriate
sized paddles.
Sternum paddle at
the base of the heart,
apex paddle at the
apex/axilla.
 Connect to
defibrillator ECG
leads to the patient
and confirm QRS
synchronization.
 Give 0.5 joule/kg,
then 1 joule/kg if
unsuccessful, then 2
joules/kg.
SVT is a diagnostic category. The correct diagnosis is a
challenge. Sinus Tachycardia is usually < 200/min, SVT
usually > 220/min. Perform an ECG in a format that can be
electronically transferred / faxed to a consultant cardiologist.
Initial Management
Examine for signs of heart failure
Secure IV line (as proximal as possible with 3 way tap)
ECG, septic work up, U+E.
If Stable:
Try vagotonic manoeuvres – oropharyngeal suction, face
immersion in cold water for 5 seconds
Do not put pressure on eyeballs.
Adenosine (IV)
Need continuous ECG
Dose = 100mcg/kg IV rapidly, follow with 2-5mls rapid 0.9%
NaCl flush
If unsuccessful – Repeat 100mcg/kg
Then give 200mcg/kg
Then 300mcg/kg
Wait 2 minutes between doses and monitor vitals.
If unsuccessful:
Contact Neonatology Consultant +/- Paediatric Cardiologist
Administration of IV anti arrhythmics other than adenosine
should only be given following this consultation.
Differential Diagnosis
 Sinus Tachycardia –
Rates up to 230 per
minute, more
variability on ECG.
 Ventricular
Tachycardia – Wider
QRS complex.
 SVTs may initially be
asymptomatic.
 Prolonged SVT can
result in heart failure
and shock.
 Sustained/
Paroxysmal SVT may
develop in utero and
may result in
hydrops
SVT is amenable to
effective treatment.
There is the potential for
poor outcome due to left
ventricular dysfunction if
it remains untreated for a
prolonged time.
If recurrent, consider Flecainide or Amiodarone in
consultation with a cardiologist
Flecainide – 1-2mg/kg 8-12 hourly pre or post feeds. Check
level before 5th dose. Therapeutic range 200-700 mcg/l
The application of synchronised DC shock is usually
undertaken by the cardiologist
Paediatrics and Neonatology Clinical Programme Algorithms
References:
1.
Kothari DS, Skinner JR. Neonatal tachycardias: an update. Arch Dis Child Fetal Neonatal Ed 2006;91: F 136-F144
2.
Dixon J, Foster K, Wyllie J, Wren C. Guidelines and adenosine dosing in supraventricular tachycardia. Arch Dis Child 2005;90:1190-1191.
3.
Sreeram N, Wren C. Supraventricular tachycardia in infants: response to initial treatment. Arch Dis Child 1990;65:127-129.
4.
APLS SVT Protocol
This care pathway has been produced by the National Paediatric and Neonatology Clinical Programme. It is aimed at medical, nursing and
allied health professionals working in Irish neonatal units.
Algorithm number:
N13
Document drafted by:
National Paediatric and Neonatology Clinical Programme
Revision number:
1.0
Document Status:
Approved
Date of Last Update:
29/8/12
Document approved by:
Paediatric and Neonatology Clinical Programme Working Group
Neonatal Clinical Advisory Group
Approval date:
13/12/12
Revision date:
January 2015