top of page


The Best in FOAM Education

  • Alison Rosser, MD

A Quick Guide to Pediatric SVT

A 12-month-old male with no significant PMH, born at full term, presents to the emergency department with cough and congestion. The nurse tells you that the heart rate is “too fast to count.”

EKG shows supraventricular tachycardia.

Patient is otherwise stable, with normal vitals. He is well appearing and interacting normally with parents and physicians in the room. Adenosine is administered twice but his rhythm does not break.

Suddenly, the patient then becomes unstable. Synchronized cardioversion is delivered. The patient’s mentation improves and EKG shows a normal sinus rhythm. Everyone breathes a sigh of relief. The patient is admitted to pediatrics for further management and workup.

Take Away #1

Non-pharmacologic options to break stable SVT

  • Ice pack to face

  • Face immersion in cold water for 30 seconds

  • Ask older child to blow into the end of a 10 cc syringe

  • Modified vagal maneuver with elevation of legs

  • Hold child upside down for 30 seconds? – shown to be effective (but something parents won’t love to see)

  • Handstand? - can also be effective with older children

Take Away #2

Medications to break stable SVT

  • Adenosine: 0.1 to 0.2 mg/kg

Other pharmacologic options

  • Procainamide 15 mg/kg IV over 30 to 60 minutes

  • Shown to be more effective than amiodarone

Take Away #3

Unstable SVT = SYNCHRONIZED Cardioversion

  • Important to make sure that machine is set to synchronized cardioversion

  • 0.5 to 1 J/kg up to 2 J/kg

  • If requiring repeated shocks, remember to reset machine back to synchronized cardioversion


Alison Rosser, MD is a current first year resident at Stony Brook Emergency Medicine.


bottom of page