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
...General Princi...
...Relevant Terms and DefinitionsArrhyth...
Diagnosis
...Differential Diagnosis for Adult Narr...
Treatment
...Treatment...
...Table 2....
Vagal maneuvers are recommended for acute...
Adenosine is recommended for acute treat...
...ed cardioversion is recommended for acute treatmen...
...hronized cardioversion is recommended for ac...
...ltiazem or verapamil can be effective for a...
IV beta blockers are reasonable for acute tr...
...and figures correspond to Class of Reco...
...Acute Treatment of SVT of Unknown...
...Tab...
...al beta blockers, diltiazem, or verapamil is us...
...dy with the option of ablation is usefu...
...SVT should be educated on how to perform vagal man...
...r propafenone is reasonable for ongoing...
...may be reasonable for ongoing management...
...ilide may be reasonable for ongoing management...
...darone may be considered for ongoing management i...
...digoxin may be reasonable for ongoing...
...e 3. Ongoing Management of SVT of Unkno...
...ISTa...
...Table 4. Ongoin...
...on for and treatment of reversible causes are re...
...is reasonable for ongoing management in patient...
...blockers may be considered for ongo...
...bination of beta blockers and ivabradine ma...
...are no specific recommendations for acute treatme...
...Nonsinus...
...Table 5. Acute Treatm...
...blockers, diltiazem, or verapamil is useful...
...ronized cardioversion is recommended for acut...
...osine can be useful in the acute s...
...may be reasonable in the acute setti...
...may be reasonable in the acute sett...
...ure 4. Acute Treatment of Suspected Foca...
...Table 6. On...
...blation is recommended in patients w...
...kers, diltiazem, or verapamil are rea...
...e or propafenone can be effective for ongoin...
...alol or amiodarone may be reasonable for ongo...
...ure 5. Ongoing Management of Focal AT...
...Table 7....
...lol or verapamil can be useful for acute...
...Table 8. Ong...
...verapamil (IIa, B-NR)573...
...tiazem (IIa, C-LD)57...
...l is reasonable for ongoing management in pat...
...ure 6. Acute Treatment of A...
Table 9...
...are recommended for acute treatment in patie...
...recommended for acute treatment in patients with A...
...nchronized cardioversion should be performed for...
...hronized cardioversion is recommended for acu...
...ckers, diltiazem, or verapamil are reasonabl...
...ockers, diltiazem, or verapamil may...
...ay be considered for acute treatment i...
...7. Ongoing Management of AVNRT...
...Table 10. Ongoi...
...or diltiazem is recommended for ongoing manag...
...ablation of the slow pathway is recommend...
...eta blockers are recommended for ongoing manage...
...nide or propafenone is reasonable for ongoing ma...
...-up without pharmacological therapy or...
...dofetilide may be reasonable for ongoing man...
...digoxin or amiodarone may be reasonable for ongoin...
...stered (“pill-in-the-pocket”) acute dose...
...Sympto...
...Table...
...uvers are recommended for acute treatment in...
...ne is beneficial for acute treatment in patients...
...ynchronized cardioversion should be performed for...
...onized cardioversion is recommended for ac...
...zed cardioversion should be performed for acute tr...
...butilide or IV procainamide is beneficial...
...m, verapamil (IIa, B-R)573...
...beta blockers (IIa, C-LD)573...
...blockers, diltiazem, and verapamil might b...
...digoxin, IV amiodarone , IV or oral beta bl...
...e 8. Acute Treatment of Orthodromic...
...Table 12. O...
...eter ablation of the accessory pathway is recommen...
...ta blockers, diltiazem, or verapamil ar...
...de or propafenone is reasonable for o...
...tilide or sotalol may be reasonable f...
...arone may be considered for ongoing management...
...beta blockers, diltiazem, or verapamil may b...
...igoxin may be reasonable for ongoing...
...al digoxin is potentially harmful for ongoin...
...9. Ongoing Management of Orthodromic AVRT...
...Asymptomatic P...
...Table 13...
...n asymptomatic patients with pre-excitation, the...
...pt loss of conduction over a manifest pathway duri...
...tent loss of pre-excitation during ECG o...
...study is reasonable in asymptomatic patients wi...
...ion of the accessory pathway is reas...
...n of the accessory pathway is reasonable in asymp...
...without further evaluation or treatment, is reas...
...ese recommendations have been desi...
...Table...
...of abrupt loss of conduction over the p...
...ttent loss of pre-excitation durin...
...useful in symptomatic patients with pre-excita...
...Atrial...
...Table 15....
...de or IV ibutilide is useful for acu...
...or oral beta blockers, diltiazem, or v...
Elective synchronized cardioversion is indicate...
...onized cardioversion is recommended for acute t...
...cing is useful for acute conversion of atrial flu...
...antithrombotic therapy is recommended in patien...
...iodarone can be useful for acute contro...
...Acute Treatment of Atrial Flutter...
...Table 16....
...atheter ablation of the CTI is useful in...
...diltiazem, or verapamil are useful to control the...
...theter ablation is useful in patients with re...
...ngoing management with antithrombotic therapy is r...
...e following drugs can be useful to ma...
...theter ablation is reasonable in patients w...
...er ablation of the CTI is reasonable in patie...
Catheter ablation is reasonable in patients with r...
...ropafenone may be considered to maintai...
...theter ablation may be reasonable for asymptomatic...
...oing Management of Atrial Flutter
...Junctional Tac...
...Table 17. Acute...
...ta blockers are reasonable for acu...
...iltiazem, procainamide, or verapamil is reaso...
...Table 18. Ongoing...
...lockers are reasonable for ongoing managem...
...tiazem or verapamil is reasonable for o...
...ide or propafenone may be reasonable for ongo...
...n may be reasonable in patients with...
...ing Management of Junctional Tachycardia...
...A...
...Table 19. Acute Treatment...
...ithrombotic therapy is recommended in ACHD pat...
...cardioversion is recommended for acute tr...
...esmolol (with extra caution using either...
...is recommended for acute treatment in ACHD patien...
IV ibutilide or procainamide can be e...
...can be effective for acute treatment in ACHD...
...onized cardioversion can be useful for ac...
...tilide or sotalol may be reasonable f...
...gure 13. Acute Treatment of SVT in ACHD Patien...
...Table 20. Ongoin...
...management with antithrombotic therapy is re...
...nt of associated hemodynamic abnormalities for p...
...tive catheter ablation or intraoperative surg...
...ral beta blockers or sotalol therapy can be use...
Catheter ablation is reasonable fo...
...on of AT or atrial flutter can be effe...
...trial pacing may be reasonable to decrease recurr...
...lide may be reasonable for prevention of re...
...y be reasonable for prevention of recu...
...inide should not be administered for treat...
...4. Ongoing Management of SVT in ACHD Patients...
...Table 21. Acute Trea...
...agal maneuvers are recommended for acute treatmen...
...enosine is recommended for acute tre...
...d cardioversion is recommended for acute trea...
...oprolol or propranolol is reasonable f...
...verapamil may be reasonable for acute trea...
...V procainamide may be reasonable for acute tr...
...ne may be considered for acute trea...
...SVT in Pregna...
...Table 22. Ongoing...
...following drugs, alone or in combinati...
...tion may be reasonable in pregnant patients wi...
...odarone may be considered for ongoin...
...SVT...
...Table 23...
...iagnostic and therapeutic approaches to SVT s...