Supraventricular Tachycardia
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
...eral Princip...
...evant Terms and DefinitionsHaving trouble v...
Diagnosis
Diagnosis
...rential Diagnosis for Adult Narrow QRS T...
Treatment
...atment
...te Treatment of SVT of Unknown Mechanism...
...are recommended for acute treatment i...
...commended for acute treatment in patie...
...ronized cardioversion is recommended...
...cardioversion is recommended for acute treatm...
...or verapamil can be effective for ac...
...are reasonable for acute treatment i...
...ors in tables and figures correspon...
...te Treatment of SVT of Unknown Mechanism...
...ngoing Management of SVT of Unknown...
...eta blockers, diltiazem, or verapamil i...
...h the option of ablation is useful for the diag...
...SVT should be educated on how to perform va...
...ide or propafenone is reasonable for o...
...talol may be reasonable for ongoing man...
...be reasonable for ongoing management in patients...
...amiodarone may be considered for ongoing...
...may be reasonable for ongoing management in pati...
...going Management of SVT of Unknown Mechanis...
...STa
...le 4. Ongoing Management of...
Evaluation for and treatment of reversible cause...
...reasonable for ongoing management in patients...
...eta blockers may be considered for ongoi...
...n of beta blockers and ivabradine may...
...o specific recommendations for acute treatment...
...s Focal AT and MAT...
Table 5. Acute Treatment of Suspected Foc...
...blockers, diltiazem, or verapamil is usefu...
...zed cardioversion is recommended for...
...can be useful in the acute setting to eit...
...amiodarone may be reasonable in the...
...lide may be reasonable in the acute setting to...
...Acute Treatment of Suspected Focal...
...able 6. Ongoing Management of Suspected...
...ter ablation is recommended in patients with symp...
...ral beta blockers, diltiazem, or vera...
...inide or propafenone can be effective for on...
...sotalol or amiodarone may be reasonable...
...going Management of Focal AT...
.... Acute Treatment of MAT...
...rolol or verapamil can be useful for acut...
...Ongoing Management of MAT...
...al verapamil (IIa, B-NR)573...
...iltiazem (IIa, C-LD)573...
...prolol is reasonable for ongoing management in...
...igure 6. Acute Treatment of...
...le 9. Acute Treatment of AVNRT...
Vagal maneuvers are recommended for acute tr...
...recommended for acute treatment in...
...chronized cardioversion should be performed for...
...zed cardioversion is recommended for acute t...
...beta blockers, diltiazem, or verapamil a...
...ers, diltiazem, or verapamil may be reasonable...
...amiodarone may be considered for acute...
.... Ongoing Management of AVNRT...
...0. Ongoing Management of AVNRT...
...pamil or diltiazem is recommended for on...
...er ablation of the slow pathway is recom...
...blockers are recommended for ongoing...
Flecainide or propafenone is reasonable for o...
...follow-up without pharmacological...
...or dofetilide may be reasonable for ongoing man...
...ral digoxin or amiodarone may be reasonab...
...inistered (“pill-in-the-pocket”) acute doses...
...mptomatic Manifest or Concealed Accessory...
...le 11. Acute Treatment of Orthodrom...
...maneuvers are recommended for acute...
...ine is beneficial for acute treatm...
...cardioversion should be performed fo...
...cardioversion is recommended for acute treat...
...cardioversion should be performed for acute...
...utilide or IV procainamide is beneficial for a...
...ltiazem, verapamil (IIa, B-...
or beta blockers (IIa, C...
...lockers, diltiazem, and verapamil might be consid...
...IV amiodarone , IV or oral beta blockers, diltia...
...8. Acute Treatment of Orthodrom...
...ngoing Management of Orthodromic A...
Catheter ablation of the accessory pa...
...ockers, diltiazem, or verapamil are indicated...
...ainide or propafenone is reasonable for ongoing...
...ral dofetilide or sotalol may be re...
...miodarone may be considered for ongoing management...
...ockers, diltiazem, or verapamil may...
...goxin may be reasonable for ongoing man...
...igoxin is potentially harmful for ongoing mana...
...9. Ongoing Management of Orthodromic AVRT
...atic Pre-Excitation...
...3. Asymptomatic Patients With Pre-Excitation...
...atic patients with pre-excitation, the finding...
...rupt loss of conduction over a manifest...
...ermittent loss of pre-excitation during ECG...
...study is reasonable in asymptomatic patie...
...ion of the accessory pathway is reason...
...n of the accessory pathway is reasona...
...ion, without further evaluation or...
...recommendations have been designated w...
.... Risk Stratification of Symptomatic Patients Wit...
...f abrupt loss of conduction over the pathway duri...
...termittent loss of pre-excitation during ECG or...
...EP study is useful in symptomatic patient...
...al Flutter...
.... Acute Treatment of Atrial Flutter...
...e or IV ibutilide is useful for acute pharmacolog...
...blockers, diltiazem, or verapamil are usefu...
...ronized cardioversion is indicated in s...
...ardioversion is recommended for acute trea...
...l pacing is useful for acute conversion of...
...ntithrombotic therapy is recommended in patie...
...iodarone can be useful for acute control o...
...igure 10. Acute Treatment of A...
...Ongoing Management of Atrial Flutter...
...heter ablation of the CTI is useful in patients wi...
...eta blockers, diltiazem, or verapamil are useful t...
Catheter ablation is useful in patients with r...
...anagement with antithrombotic therapy is rec...
...ugs can be useful to maintain sinus rhythm in pat...
...ion is reasonable in patients with CTI-dependen...
...ablation of the CTI is reasonable in...
...theter ablation is reasonable in patients...
...or propafenone may be considered to maintai...
...ablation may be reasonable for asymptomatic...
...ing Management of Atrial Flutter...
...nctional Tachycard...
...e Treatment of Junctional Tachycard...
...rs are reasonable for acute treatment in pa...
..., procainamide, or verapamil is reasonabl...
...18. Ongoing Management of Junctio...
...al beta blockers are reasonable for ongoing manage...
...tiazem or verapamil is reasonable for ongoing ma...
...opafenone may be reasonable for ongoing managem...
...tion may be reasonable in patients...
...ngoing Management of Junctional Tac...
...CHD...
Table 19. Acute Treatment o...
...ute antithrombotic therapy is recom...
Synchronized cardioversion is recommended for...
...diltiazem or esmolol (with extra caution...
...denosine is recommended for acute treatment in...
...ide or procainamide can be effective for...
...can be effective for acute treatmen...
...synchronized cardioversion can be us...
...ide or sotalol may be reasonable f...
.... Acute Treatment of SVT in ACHD Patients...
...le 20. Ongoing Management...
...management with antithrombotic therapy is...
...associated hemodynamic abnormalitie...
...erative catheter ablation or intraope...
...beta blockers or sotalol therapy can...
...lation is reasonable for treatment of recurre...
...blation of AT or atrial flutter can be ef...
...ay be reasonable to decrease recurrences of AT o...
...ral dofetilide may be reasonable for prev...
...ne may be reasonable for prevention of recurr...
...de should not be administered for trea...
...Ongoing Management of SVT in ACHD...
...cute Treatment of SVT in Pregnancy...
...uvers are recommended for acute treatment in p...
...is recommended for acute treatment i...
...onized cardioversion is recommended for acute...
...metoprolol or propranolol is reasonabl...
IV verapamil may be reasonable for acute treatm...
...may be reasonable for acute treatme...
...V amiodarone may be considered for acute...
...T in Pregnancy
Table 22. Ongoing Management of SVT in P...
...owing drugs, alone or in combination, can be...
...heter ablation may be reasonable i...
...arone may be considered for ongoing...
...Older Population...
...Treatment of SVT in Older Populations...
...gnostic and therapeutic approaches to SVT shoul...