What is the next step in management after a stable patient with PSVT does not respond to vagal maneuvers?

In the management of a stable patient with Paroxysmal Supraventricular Tachycardia (PSVT) who does not respond to vagal maneuvers, the recommended next step is the administration of adenosine. Adenosine is an effective pharmacological intervention specifically used to interrupt the reentrant circuits that are often responsible for PSVT. It works by temporarily blocking the conduction through the atrioventricular (AV) node, which can restore normal sinus rhythm.

When vagal maneuvers, such as the Valsalva maneuver or carotid sinus massage, fail, adenosine is often the first-line medication to rapidly control the tachycardia because it acts almost immediately (within seconds) and can terminate PSVT in many cases. Proper administration is critical; it should be given as a rapid IV bolus, followed by a saline flush to ensure it reaches the systemic circulation without delay.

Other options such as verapamil, cardioversion, and beta-adrenergic agonists are usually reserved for different circumstances or follow-up treatments. Verapamil is a calcium channel blocker that can be effective but is typically considered if adenosine is unsuccessful. Cardioversion is more commonly used in unstable