Toward diagnostic precision and context-adaptive therapy in prehospital supraventricular tachycardia

The recent scoping review by Gamberini et al. provides a comprehensive overview of the prehospital diagnosis and management of supraventricular tachycardia (SVT), while highlighting substantial heterogeneity in diagnostic accuracy, therapeutic strategies, and emergency medical service (EMS) practices. In this Matter Arising, we build upon their work by discussing key challenges and opportunities for advancing prehospital SVT care. We emphasize the importance of improving diagnostic precision through telemedicine-enabled electrocardiogram interpretation and emerging artificial intelligence-assisted decision support, strengthening implementation of evidence-based non-pharmacological interventions such as the modified Valsalva manoeuvre, optimizing adenosine use based on evolving evidence, and considering the implications of variations in EMS systems and international guideline recommendations. We further highlight the need to interpret existing evidence in the context of temporal heterogeneity, predominantly observational data, and differences in prehospital care models. Future research should focus on prospective multicentre studies, standardized outcome reporting, and implementation strategies that support precision-guided, context-adaptive prehospital SVT management.