BACKGROUND: Supraventricular tachycardia (SVT) is a common presenting arrhythmia in the general population. Cases of SVT presenting during commercial air travel are always challenging as they might be confused with other conditions requiring different treatment strategies. We present a case of an in-flight SVT that was successfully managed using telemedicine support.CASE REPORT: A 33-yr-old woman developed chest pain and dizziness while on an international commercial flight. Vital signs obtained on an on-board telemedicine device recorded an initial heart rate and blood pressure of 220 bpm and 128/78 mmHg, respectively. An electrocardiogram (ECG) was also obtained and transmitted to the ground-based medical support (GBMS) center where an SVT was diagnosed. Vagal maneuvers were recommended which resulted in a return to sinus rhythm and stabilization of the patient.DISCUSSION: In parallel to the global increase in commercial air travel, it is expected that the incidence of in-flight arrhythmias will also increase, including SVTs. Vagal maneuvers are a safe, first-line option. While treating patients with a symptomatic tachyarrhythmia it is essential to diagnose the underlying arrhythmia, especially when initial maneuvers fail. Telemedicine, with transmission of vital signs and ECGs to GBMS centers, can enable diagnosis and guide management of in-flight SVTs, distinguishing them from other forms of cardiac arrhythmia. Undifferentiated chest pain and dizziness are common causes for flight diversions and, as such, could potentially be prevented in some instances by using telemedicine.Voerman JJ, Hoffe ME, Surka S, Alves PM. In-flight management of a supraventricular tachycardia using telemedicine. Aerosp Med Hum Perform. 2018; 89(7):657–660.