Immediate electrical cardioversion is recommended for acute treatment of SVT with haemodynamic instability.Guideline rec
Class ILevel CRec Table 14 · §12.4 · p.4525
Arrhythmias and devices
Topics
Arrhythmias (§12.4)
Primary arrhythmia syndromes (§6.2)
Output
New-onset narrow QRS tachycardia §12.4.1.1 · Rec Table 14
Acute management of SVT and AF
Vagal manoeuvres and i.v. adenosine are recommended for conversion of haemodynamically stable supraventricular tachycardias.Guideline rec
Class ILevel CRec Table 14 · §12.4 · p.4525
Narrow QRS tachycardiaFigure 14 (printed p4523) · step through its branchpoints
New-onset narrow QRS (<120 ms) tachycardias in pregnancy are treated according to haemodynamic stability. In all cases with haemodynamic instability caused by any supraventricular tachycardia (SVT) including AF and AFL, synchronized, direct current cardioversion is indicated (Figure 14). The foetal heart rate should be closely monitored after cardioversion. In haemodynamically stable narrow QRS tachycardias, the use of vagal manoeuvres (modified Valsalva manoeuvre, carotid sinus massage) may terminate an atrioventricular (nodal) re-entry tachycardia (AV(N)RT) arrhythmia.
No class printed§12.4.1.1, printed p4522 [TXT]
If these manoeuvres fail, i.v. adenosine (6–18 mg bolus) is recommended for termination of AV(N)RT. Intravenous beta-1-selective blockers (preferably metoprolol) can be administered for all SVTs, which either terminate the SVT or slow AV conduction and thereby the ventricular rate. Intravenous beta-1-selective blockers (metoprolol), non-dihydropyridine CCBs (verapamil), and digoxin can be used safely. In stable patients without structural heart disease, flecainide and ibutilide may be considered for termination of AF and AFL (Figure 15). In patients with congenital disease, synchronized, direct current cardioversion may be preferred.
No class printed§12.4.1.1, printed p4523 [TXT]
Arrhythmias (§12.4)
Arrhythmia may have serious effects on the health of both the mother and the foetus and should be treated similarly to arrhythmias in non-pregnant women.
No class printed§12.4, printed p4522 [TXT]
- Adenosine 6–18 mg bolus. Figure 14, footnote a [FIG]
- Atenolol contraindicated. Figure 14, footnote b [FIG]
- Metoprolol 2.5–15 mg. Figure 14, footnote c [FIG]
- Verapamil 2.5–10 mg bolus over 5 min. Figure 14, footnote d [FIG]
- II Most supraventricular arrhythmias.
Table 6 does not say which supraventricular arrhythmias fall outside 'most'.
- Verapamil i.v. is printed three ways: '2.5–10 mg bolus over 5 min' (Figure 14, footnote d), '2.5–1 mg bolus over 5 min' (Figure 15, footnote c) and '5–10 mg bolus' (Supplementary Table S6). Each is shown as printed with its source; the Figure 15 value is flagged for review.
Educational summary of the 2025 ESC Guidelines. It does not replace clinical judgement or local protocol.