Question:medium
A 32-year-old male with history of recurrent paroxysmal supraventricular tachycardia is stable in sinus rhythm. What is the best choice for long-term prophylaxis?
A 32-year-old male with history of recurrent paroxysmal supraventricular tachycardia is stable in sinus rhythm. What is the best choice for long-term prophylaxis?
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PSVT acute termination = adenosine; long-term prophylaxis may use oral diltiazem or beta blockers.
Updated On: May 14, 2026
- IV adenosine
- IV esmolol
- Oral diltiazem
- IV amiodarone
Show Solution
The Correct Option is C
Solution and Explanation
Step 1: Understanding the Question:
The question asks for "long-term prophylaxis" (prevention of recurrence) for PSVT in a patient who is currently stable.
Step 2: Detailed Explanation:
Acute vs. Long-term Management:
- IV Adenosine (A): This is the drug of choice for terminating an acute episode of PSVT. It has a half-life of seconds and cannot be used for prophylaxis.
- IV Esmolol (B): Used for acute rate control in a hospital setting.
Prophylaxis Options: Patients with recurrent, symptomatic PSVT can be managed with daily oral medications or Radiofrequency Ablation (which is often the definitive treatment).
Pharmacological Prophylaxis: First-line oral agents include Beta-blockers (like Metoprolol) or Non-dihydropyridine Calcium Channel Blockers (like Diltiazem or Verapamil). These drugs slow conduction through the AV node, which is usually part of the re-entry circuit in PSVT (AVNRT or AVRT).
Diltiazem (C): It is a suitable oral agent for long-term suppression of the re-entrant tachycardia.
Amiodarone (D): Usually reserved for more complex ventricular arrhythmias or atrial fibrillation in structural heart disease due to its significant long-term side-effect profile.
Step 3: Final Answer:
For long-term oral prophylaxis of recurrent PSVT, oral Calcium Channel Blockers like Diltiazem are an appropriate and standard choice.
The question asks for "long-term prophylaxis" (prevention of recurrence) for PSVT in a patient who is currently stable.
Step 2: Detailed Explanation:
Acute vs. Long-term Management:
- IV Adenosine (A): This is the drug of choice for terminating an acute episode of PSVT. It has a half-life of seconds and cannot be used for prophylaxis.
- IV Esmolol (B): Used for acute rate control in a hospital setting.
Prophylaxis Options: Patients with recurrent, symptomatic PSVT can be managed with daily oral medications or Radiofrequency Ablation (which is often the definitive treatment).
Pharmacological Prophylaxis: First-line oral agents include Beta-blockers (like Metoprolol) or Non-dihydropyridine Calcium Channel Blockers (like Diltiazem or Verapamil). These drugs slow conduction through the AV node, which is usually part of the re-entry circuit in PSVT (AVNRT or AVRT).
Diltiazem (C): It is a suitable oral agent for long-term suppression of the re-entrant tachycardia.
Amiodarone (D): Usually reserved for more complex ventricular arrhythmias or atrial fibrillation in structural heart disease due to its significant long-term side-effect profile.
Step 3: Final Answer:
For long-term oral prophylaxis of recurrent PSVT, oral Calcium Channel Blockers like Diltiazem are an appropriate and standard choice.
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