What is the treatment of choice for stable SVT?

• A. Amiodarone
• B. Beta-blocker only
• C. Intravenous adenosine
• D. Digoxin

Answer: (C)

In stable SVT, the goal is to rapidly interrupt the AV node–dependent reentry that’s driving the tachycardia. Adenosine is ideal for this because it acts almost instantly to briefly block conduction through the AV node and then resets the rhythm back to sinus. Its effect is very short-lived, so the patient often converts to normal rhythm quickly and recovers with minimal delay. That’s why a rapid IV push of adenosine, followed by a saline flush, is the treatment of choice for acute termination. The usual approach is a 6 mg dose, with a possible 12 mg dose if there’s no response, all while monitoring closely for the brief pause in rhythm and any side effects.

Other options aren’t as effective for immediate termination of a stable SVT. Amiodarone has a slower onset and is typically reserved for VT or refractory SVT. Beta-blockers and digoxin can slow AV conduction but aren’t as reliable for a rapid, terminating effect in an acute setting and may cause hypotension or other issues in some patients.