Supraventricular Tachycardia

Publication Date: September 23, 2015

Key Points

Key Points

  • The writing committee generated a clinical practice guideline that provides for high-quality, evidence-based decision making for patients with SVT.
  • The “2015 ACC/AHA/HRS Guideline for the Management of Adult Patients with Supraventricular Tachycardia” replaces the “2003 ACC/AHA/ESC Guidelines for the Management of Patients with Supraventricular Arrhythmias”. It utilizes new knowledge from clinical trials, treatments and drugs, and updates or replaces recommendations.
  • Atrial fibrillation is not included in this guideline.
  • Shared decision making is stressed in the document with attention to the patient’s preferences and treatment goals and their individual situations.
  • The best available evidence indicates that the prevalence of SVT in the general population is 2.29 per 1,000 persons, and the incidence of PSVT is estimated to be 36 per 100,000 persons per year.
  • Women have twice the risk of men of developing PSVT. Individuals >65 years of age have >5 times the risk of younger persons of developing PSVT.
  • SVT has an impact on quality of life, which varies according to the frequency of episodes, the duration of SVT, and whether symptoms occur not only with exercise but also AT rest.
  • While drug therapy is largely unchanged from 2003, there is one exception. Ivabradine is a new class of drug that has unique properties for reduction of the heart rate. The guideline provides new recommendations for use of ivabradine for ongoing management in patients with inappropriate sinus tachycardia.
  • Ablation techniques have improved, including techniques to minimize radiation exposure. As such, catheter ablation may be reasonable in pregnant patients with highly symptomatic, recurrent, drug-refractory SVT with efforts toward minimizing radiation exposure.
  • This guideline also provides new recommendations for the management of patients with asymptomatic WPW pattern, based on a systematic review of the evidence.

General Principles

...ral Principles...

...vant Terms and DefinitionsHaving trouble...


Diagnosis

...gnosis

...ure 1. Differential Diagnosis for Adult Narrow QRS...


Treatment

...atment...

...e 2. Acute Treatment of SVT of Unknow...

...l maneuvers are recommended for acute trea...

...recommended for acute treatment in patients...

...onized cardioversion is recommended...

...ynchronized cardioversion is recomme...

...iazem or verapamil can be effective for acute trea...

IV beta blockers are reasonable for acute treat...

Colors in tables and figures correspond to Class...


...cute Treatment of SVT of Unknown Mechanism...


...ing Management of SVT of Unknown Mechanism...

...l beta blockers, diltiazem, or verapamil...

...P study with the option of ablation is...

Patients with SVT should be educat...

...e or propafenone is reasonable for ongoing man...

...be reasonable for ongoing management in pati...

...lide may be reasonable for ongoing manage...

...darone may be considered for ongoi...

...may be reasonable for ongoing mana...


...ng Management of SVT of Unknown Mechanism...


...STa...

.... Ongoing Management of IST...

...and treatment of reversible causes ar...

...bradine is reasonable for ongoing management...

...may be considered for ongoing manageme...

...he combination of beta blockers and ivabradine m...

...no specific recommendations for acu...


...nsinus Focal AT and MAT...

Table 5. Acute Treatment of Suspected Foca...

...ockers, diltiazem, or verapamil is usef...

...ized cardioversion is recommended for acute...

...be useful in the acute setting to either restore...

...y be reasonable in the acute setti...

...ide may be reasonable in the acute setting...


...e Treatment of Suspected Focal AT...


Table 6. Ongoing Management of Suspected Focal AT

...ter ablation is recommended in patients with...

...ers, diltiazem, or verapamil are reasona...

...e or propafenone can be effective for...

...talol or amiodarone may be reasonable for on...


...ngoing Management of Focal AT...


...ble 7. Acute Treatment of MAT

...metoprolol or verapamil can be useful for acute t...


...8. Ongoing Management of MAT...

...ral verapamil (IIa, B-NR)5...

...zem (IIa, C-LD)573

...s reasonable for ongoing management in patien...


...re 6. Acute Treatment o...


...le 9. Acute Treatment of AV...

...al maneuvers are recommended for acute t...

...ine is recommended for acute treatment in...

...hronized cardioversion should be p...

...ed cardioversion is recommended for acute treat...

...ta blockers, diltiazem, or verapam...

...blockers, diltiazem, or verapamil may be...

...may be considered for acute treatment in hemod...


...7. Ongoing Management of...


...ngoing Management of AVNRT...

...l verapamil or diltiazem is recommended...

Catheter ablation of the slow pathway is recommen...

...blockers are recommended for ongoing management...

...propafenone is reasonable for ongoing manageme...

...ow-up without pharmacological therapy or abl...

...ol or dofetilide may be reasonable for ongoing...

...oxin or amiodarone may be reasonable for o...

...nistered (“pill-in-the-pocket”) a...


...ptomatic Manifest or Concealed Acce...

...11. Acute Treatment of Orthodromic AVRT...

...agal maneuvers are recommended for acute tr...

...ine is beneficial for acute treatment i...

Synchronized cardioversion should be pe...

...cardioversion is recommended for a...

...ronized cardioversion should be pe...

...tilide or IV procainamide is benefi...

...azem, verapamil (IIa, B-R)573...

...ockers (IIa, C-LD)573...

...blockers, diltiazem, and verapamil might be con...

IV digoxin, IV amiodarone , IV or oral...

...ure 8. Acute Treatment of Ortho...

Table 12. Ongoing Management of Orthodromic AVRT

...eter ablation of the accessory pathw...

...beta blockers, diltiazem, or verapamil are...

...ainide or propafenone is reasonable for ongoin...

...l dofetilide or sotalol may be reasonable...

...miodarone may be considered for ongoi...

...al beta blockers, diltiazem, or verapamil m...

Oral digoxin may be reasonable for ongoin...

...oxin is potentially harmful for ongoing managemen...

...9. Ongoing Management of Orthodromic AVRT...


...ymptomatic Pre-Exci...

...symptomatic Patients With Pre-Excitation...

...ic patients with pre-excitation, the f...

...pt loss of conduction over a manifest p...

...termittent loss of pre-excitation during ECG or a...

An EP study is reasonable in asymptomatic patient...

...ion of the accessory pathway is reaso...

...r ablation of the accessory pathway is...

Observation, without further evaluation or t...

...mendations have been designated with t...

...e 14. Risk Stratification of Symptomatic...

...ings of abrupt loss of conduction over th...

or intermittent loss of pre-excitation d...

An EP study is useful in symptomatic patien...


...al Flutter...

...Acute Treatment of Atrial Flutter...

...ral dofetilide or IV ibutilide is useful...

...a blockers, diltiazem, or verapamil...

...ive synchronized cardioversion is in...

...ized cardioversion is recommended for...

...d atrial pacing is useful for acute c...

...thrombotic therapy is recommended in patie...

...can be useful for acute control of the ventric...

...Acute Treatment of Atrial Flutter...

...ble 16. Ongoing Management of Atri...

Catheter ablation of the CTI is useful in patient...

...ers, diltiazem, or verapamil are useful to control...

...r ablation is useful in patients with...

...g management with antithrombotic therapy...

...he following drugs can be useful to...

...ation is reasonable in patients with C...

...ablation of the CTI is reasonable in...

...ablation is reasonable in patients with recurrent...

...ecainide or propafenone may be considered to maint...

...tion may be reasonable for asymptomatic pat...

...11. Ongoing Management of Atrial Flutter


...tional Tachycardia...

...e Treatment of Junctional Tachycardia...

...kers are reasonable for acute treatment i...

...zem, procainamide, or verapamil is reas...

...e 18. Ongoing Management of Junction...

...blockers are reasonable for ongoing...

...r verapamil is reasonable for ongoing manageme...

...ide or propafenone may be reasonable for ongoi...

...n may be reasonable in patients with...

...e 12. Ongoing Management of Junctiona...


ACHD

...le 19. Acute Treatment of...

...hrombotic therapy is recommended in ACHD p...

...rdioversion is recommended for acute treatment...

...ltiazem or esmolol (with extra caution u...

...denosine is recommended for acute tre...

...e or procainamide can be effective for acute...

...al pacing can be effective for acute treatm...

...nized cardioversion can be useful for acute termin...

...fetilide or sotalol may be reasonable for acu...

...igure 13. Acute Treatment of SVT in ACHD...

...Ongoing Management of ACH...

...nagement with antithrombotic therapy is recommende...

...ssment of associated hemodynamic abnormali...

...e catheter ablation or intraoperative su...

...ta blockers or sotalol therapy can be useful fo...

...eter ablation is reasonable for treat...

...tion of AT or atrial flutter can be effecti...

...trial pacing may be reasonable to decrease recur...

...e may be reasonable for prevention o...

...be reasonable for prevention of recurrent AT or a...

...ould not be administered for treat...

...ing Management of SVT in ACHD Patients...

...e Treatment of SVT in Pregnancy...

...gal maneuvers are recommended for acute t...

...enosine is recommended for acute tr...

...onized cardioversion is recommended...

...prolol or propranolol is reasonable for acute...

...y be reasonable for acute treatment in pregnant p...

...amide may be reasonable for acute treatment i...

...arone may be considered for acute tr...


...T in Pregnancy

...ble 22. Ongoing Management of SVT in Pre...

...drugs, alone or in combination, can be ef...

...ter ablation may be reasonable in pregnant...

...ne may be considered for ongoing man...


SVT in Older Populati...

...ute Treatment of SVT in Older Populations...

...iagnostic and therapeutic approaches to...