What should always be the first choice for managing stable SVT?

The first choice for managing stable supraventricular tachycardia (SVT) is the vagal maneuver because it helps stimulate the vagus nerve, which can slow down the heart rate and restore normal rhythm. This non-invasive technique takes advantage of the body's natural mechanisms to combat the fast heart rate caused by SVT.

Vagal maneuvers can include activities such as having the patient perform a Valsalva maneuver, immersing the face in cold water, or coughing. These methods are often effective in adults and children and are considered first-line interventions, especially when the patient is stable and does not exhibit any signs of significant distress or hemodynamic instability.

In cases where vagal maneuvers are unsuccessful, other options like medication, cardioversion, or defibrillation may be considered based on the patient's condition and response to initial treatments. However, starting with vagal maneuvers provides a safe and effective means of addressing stable SVT without exposing the patient to the potential risks associated with pharmacological or electrical interventions.