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Home-based Solutions for SVT Management
Dr Benjamin A Steinberg, MD, MHS, FACC, FHRS
Cardiovascular Medicine Division, University of Utah, Salt Lake City, USA
Diagnosis and management of supraventricular tachycardia (SVT) can be challenging, given its paroxysmal nature. Episodes may occur long enough to be symptomatic, but too short to allow for diagnostic testing in urgent care or emergency departments. Longer, confirmed episodes may persist for hours and require emergency department care for acute management and termination. Contemporary non-invasive SVT management requires additional tools that are more effective, safer, and more comfortable for patients.
Ambulatory electrocardiography studies can diagnose SVT during the period of the study, typically up to 30 days. However, events not occurring during this window can go undiagnosed, or require and implantable loop recorders for more prolonged diagnostics.
The University of Utah is developing pioneering infrastructure in the management of arrhythmias, including SVT. In order to address a major challenge, and opportunity, in diagnosis, we are leveraging the power of consumer-based ECG devices to capture rare, but highly symptomatic events that might otherwise go undiagnosed. Using a novel, electronic health record infrastructure, patients will be able to submit directly to their treatment team, ECGs recorded using consumer-based devices, such as the Apple Watch. These tracings can then be reviewed and adjudicated by the University of Utah electrophysiology team (Figure), facilitating earlier diagnosis and patient management.
An additional burden among patients with symptomatic SVT requiring non-invasive management, is the necessary emergency department visits for episodes that do not terminate at home. The University of Utah is among only a handful of centers participating in the NODE-303 trial, in order to establish intranasal etripamil as a home-based solution for SVT management.
An investigational, acute AV nodal blocker, etripamil can facilitate SVT termination in the comfort of patients’ homes, avoiding unnecessary emergency department visits, and the adverse side effects of adenosine for SVT termination.
Patients with SVT can face challenges in diagnosis and management. The electrophysiology program at the University of Utah is working to address these challenges, and improve the effectiveness, safety, and convenience of diagnosis and management for patients with SVT.