Management of supraventricular tachycardia in primary care

Abstract

Supraventricular tachycardia is one of the most frequently managed rapid arrhythmias in emergency departments; it is generally characterized by narrow QRS complexes (≤ 120 ms) and a heart rate > 100 beats/min. Standard treatment involves electrical cardioversion or intravenous administration of adenosine, beta-blockers, or calcium-channel antagonists. In primary care, however, these resources are often scarce, delaying conversion and exposing patients to progression toward more severe arrhythmias. We reviewed scientific literature (2020–2025) to design a therapeutic algorithm suitable for resource-limited settings. Inclusion-adult studies, systematic reviews, guidelines, and case reports in Spanish/English, out-of-hospital settings; exclusion-surgical scenarios. Findings confirm that the modified Valsalva maneuver is the most effective and safest initial intervention: it restores sinus rhythm in 43 % on the first attempt and up to 60 % after three repetitions space 60 seconds apart. If it fails and no vascular contraindications exist, sequential carotid-sinus massage can be added, providing a practical option where intravenous adenosine, beta-blockers, or calcium-channel antagonists are unavailable, thereby strengthening first-level response capacity.