Supraventricular arrhythmias involve abnormal heartbeats originating above the ventricles in the heart’s lower chambers. These arrhythmias can occur at any age and may be due to numerous factors. Superior ventricular arrhythmias can affect the atria or the AV node, which is the junction connecting the atria and ventricles. This may cause various types of arrhythmias or abnormal rhythms of the heart. Symptoms associated with supraventricular arrhythmias include lightheadedness, chest pain, palpitations and shortness of breath. 

Atrial fibrillation (AFib) being the most prevalent supraventricular arrhythmia impacts a population of 1% to 2% globally. AFib is especially prevalent in older patients and worldwide prevalence of supraventricular arrhythmias increases with cardiovascular age, regional, and population differences. 

AFib is a condition that is characterized by multiple reentrant circuits in the atrial chambers when triggered by ectopic foci or rapid firing from sites like the pulmonary veins. Fibrosis, inflammation and atrial dilation were associated with structural changes in the atrial wall which help maintain AFib. Atrial flutter observed is rapid, and regular atrial rhythms due to reentrant circuits; majority of which originate from the right atrium. 

AFib and atrial flutter can arise from structural alterations that develop areas of aberrant impulse transmission. Mutations in genetic codes that affect ion channels and/or proteins in cardiac conduction can cause electrical dysfunctions that could predispose the individual to arrhythmias. Atrial remodeling predisposes to reentrant circuits and abnormal electrical activity resulting in AFib. Genetic alterations in ion channels, gap junctions, or other structural proteins may lead to conduction abnormalities contributing to arrhythmias. 

The outcome of supraventricular arrhythmias depends on the type and degree of severity of the condition, and the presence of coexisting heart disease such as congenital heart disease, cardiomyopathy, coronary artery disease and valvular heart diseases. Patient outcomes depend on the results of any medications, such as antiarrhythmic drugs, rate control, catheter ablation, and other methods. Abnormal formations can influence the treatment process and become a risk factor for adverse outcomes. 

It can occur in infants, children, and adolescents, although they are relatively less common compared to adults.  

They also affect young adults, typically those in their 20s, 30s, and 40s.  

• Cardiac Examination: Check for other pulsations such as atrial fibrillation/flutter waves or any irregularities in the pulsation.
• Peripheral Examination: Check for symptoms of poor blood circulation like pale, blue or cold skin. Observe for jugular venous distention or peripheral edema indicative of heart failure secondary to venous congestion.
• Respiratory Examination: It is also important to inquire for symptoms of worsening of heart failure such as increase in the work of breathing, shortness of breath or breathlessness that worsens on lying down or in the supine position. 

Palpitations, awareness of an irregular or fast heartbeat, mild dyspnea, light-headedness, exhaustion, and chest pain are among the mild to moderate symptoms that many SVA patients encounter.  

Intermittent episodes of arrhythmia may cause these symptoms, which may go away on their own or may get better with arrhythmia termination.  

Acute onset of symptoms may occur suddenly and may be triggered by factors such as stress, exertion, stimulant use, or electrolyte imbalances. 

• Acute Management: Some nonsurgical interventions, including carotid sinus massage, cold face immersion can be used to stop some of these SVAs especially paroxysmal supraventricular tachycardia (PSVT).
• Rhythm Control Strategies: Beta-blockers, calcium channel blockers, class I or class III antiarrhythmic agents are some of the drugs used in controlling rhythm in SVAs. 
• Cardioversion: Electrical/shock or pharmacological cardioversion could be done to treat patients with symptomatic or long-standing SVA such as atrial fibrillation/flutter. 
• Long-term Management: Long-term antiarrhythmic medications can be used to prevent the reoccurrence of sinus tachycardia in those who experience frequent or severe symptoms. 

Cardiology, General

Neurology

• Stress Reduction: Stress is known to precipitate or worsen SVAs in people who are vulnerable to such episodes. Non-pharmacological interventions like practicing deep breathing, meditation, yoga, or mindfulness-based stress reduction may be effective to decrease the frequency of occurrence or severity of arrhythmia episodes.
• Dietary Modifications: The triggering of SVAs may be associated with the consumption of heavy meals, spicy foods or alcohol.
• Sleep Hygiene: Reduced sleep quantity or sleep quality may therefore increase the risk of arrhythmia. Promoting the right habits and behaviors before going for a sleep such as; taking to the bed and waking up at the same time, ensuring that the bedroom environment is conducive for sleep, avoiding known and possible sources of stress before going to bed.
• Exercise: It is recommended that patients with known SVAs avoid high-intensity exercise, as vigorous exercise can cause SVAs in susceptible patients. 
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Cardiology, General

Internal Medicine

Metoprolol: It is a selective beta-1 adrenergic receptor antagonist that has been approved for the management of SVAs. This decreases cardiac contractility and rate together with dromotropic effect but has little effect on β2 receptors in the lungs and peripheral vasculature. 

Cardiology, General

Diltiazem: This is a non-dihydropyridine calcium channel blocker commonly used in the management of SVAs. It selectively inhibits calcium channels in cardiac myocytes and the AV node, thus exhibiting negative chronotropic and dromotropic effects. 

Cardiology, General

Catheter ablation: It is usually done in an electrophysiology laboratory while the patient is under conscious sedation or general anesthesia. In the process, catheters are passed via the femoral vein into the heart and the target site is identified using fluoroscopy and electroanatomic mapping systems. 

Cardiology, General

• Diagnostic Phase: This phase depicts the initial stages of screening and assessment of SVAs. It involves physical assessment of vital organs and systems including vital signs, cardiovascular assessment and search for predisposing symptoms of heart diseases or other related conditions. 
• Acute Management Phase: This phase is centered on the management of symptoms of SVAs and contains the following:
  Medications such as antiarrhythmic drugs that tend to stabilize the hemodynamic of the patient or rate control agents to manage symptoms during flare-ups. 
• Stabilization Phase: In managing acute arrhythmia episodes, follow-up is taken towards identifying and treating the causes of the arrhythmia to reduce its probability of recurring. 
• Long-term Management Phase: The main focus of this phase of management is geared towards ensuring that the patient maintains sinus rhythm, managing the symptoms and preventing the reoccurrence of SVAs. 
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