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 Principles...
...able 1. Relevant Terms and Definit...
Diagnosis
...gnosis
...igure 1. Differential Diagnosis for Adult...
Treatment
Treatme...
...e Treatment of SVT of Unknown Mechan...
...euvers are recommended for acute treatment in p...
...is recommended for acute treatment in pat...
...ardioversion is recommended for acute...
...ronized cardioversion is recommended for acute...
IV diltiazem or verapamil can be effective...
...blockers are reasonable for acute treatment...
...in tables and figures correspond to Class...
...ure 2. Acute Treatment of SVT of Unknown...
...3. Ongoing Management of SVT of Unknown M...
...l beta blockers, diltiazem, or verapa...
...ith the option of ablation is usefu...
...atients with SVT should be educated on how...
...propafenone is reasonable for ongoing ma...
...y be reasonable for ongoing management...
...may be reasonable for ongoing management in patie...
...ral amiodarone may be considered for ongoing manag...
...y be reasonable for ongoing management in...
...igure 3. Ongoing Management of SVT of...
IST...
...4. Ongoing Management of...
...or and treatment of reversible caus...
...ine is reasonable for ongoing management in...
...y be considered for ongoing management in...
...ation of beta blockers and ivabrad...
...no specific recommendations for acute tre...
...us Focal AT and MAT...
...able 5. Acute Treatment of Suspected Focal AT
...lockers, diltiazem, or verapamil is useful f...
...rdioversion is recommended for acute...
...be useful in the acute setting to either rest...
...V amiodarone may be reasonable in the acute settin...
...ilide may be reasonable in the acute setting to...
...e 4. Acute Treatment of Suspected Focal AT...
.... Ongoing Management of Suspected Focal AT...
...heter ablation is recommended in pati...
...kers, diltiazem, or verapamil are reasonable for...
...r propafenone can be effective for...
...ral sotalol or amiodarone may be re...
.... Ongoing Management of Focal AT...
.... Acute Treatment of MA...
...r verapamil can be useful for acut...
...ble 8. Ongoing Management...
...apamil (IIa, B-NR)573...
...zem (IIa, C-LD)573...
...lol is reasonable for ongoing management in...
...Acute Treatment of AVNRT...
...ble 9. Acute Treatment of AVNRT
...euvers are recommended for acute treatment in p...
...ommended for acute treatment in patients with AVN...
...zed cardioversion should be performed for acute t...
Synchronized cardioversion is recommended for acut...
...kers, diltiazem, or verapamil are reasonable f...
...rs, diltiazem, or verapamil may be reasonable for...
...odarone may be considered for acute treatment in...
...gure 7. Ongoing Management of...
...ngoing Management of AVNRT...
...or diltiazem is recommended for ongoing m...
...ablation of the slow pathway is recommended in p...
...a blockers are recommended for ongoing ma...
...or propafenone is reasonable for ongoing man...
...l follow-up without pharmacological therapy...
...l sotalol or dofetilide may be reasonab...
...ral digoxin or amiodarone may be reasonable for...
...d (“pill-in-the-pocket”) acute doses of or...
...atic Manifest or Concealed Accessory Pat...
...able 11. Acute Treatment of Orthodrom...
...l maneuvers are recommended for acute trea...
...eneficial for acute treatment in patients with ort...
...cardioversion should be performed for a...
...cardioversion is recommended for ac...
...ed cardioversion should be performed for acute t...
...IV procainamide is beneficial for a...
...iazem, verapamil (IIa, B-R)...
...ta blockers (IIa, C-LD)573...
...ers, diltiazem, and verapamil migh...
...amiodarone , IV or oral beta blockers, dilti...
...8. Acute Treatment of Orthodromic AVRT...
...12. Ongoing Management of Orthodromic AVRT...
...lation of the accessory pathway is rec...
...al beta blockers, diltiazem, or verapamil...
...nide or propafenone is reasonable for ongoin...
...l dofetilide or sotalol may be reaso...
...e may be considered for ongoing man...
...al beta blockers, diltiazem, or verapamil m...
...in may be reasonable for ongoing management of...
...is potentially harmful for ongoing...
...9. Ongoing Management of Orthodr...
...tomatic Pre-Excita...
...Asymptomatic Patients With Pre-Excitation...
...ptomatic patients with pre-excitation, the f...
...brupt loss of conduction over a manifest pathway...
...termittent loss of pre-excitation during ECG or am...
...study is reasonable in asymptomatic patients w...
...theter ablation of the accessory pathway is r...
...on of the accessory pathway is reasonable...
...on, without further evaluation or treatment, is...
...ommendations have been designated with the notatio...
...4. Risk Stratification of Symptomati...
...findings of abrupt loss of conduct...
...ermittent loss of pre-excitation during EC...
...seful in symptomatic patients with pre-...
...trial Flutt...
...te Treatment of Atrial Flutter...
...lide or IV ibutilide is useful for ac...
...oral beta blockers, diltiazem, or verapamil...
...lective synchronized cardioversion is indicate...
...dioversion is recommended for acute trea...
...cing is useful for acute conversion of atr...
...mbotic therapy is recommended in patients with at...
...can be useful for acute control of th...
...Acute Treatment of Atrial Flutter...
.... Ongoing Management of Atrial Flutter...
...lation of the CTI is useful in patients w...
...blockers, diltiazem, or verapamil are u...
Catheter ablation is useful in patients...
...ement with antithrombotic therapy is rec...
...owing drugs can be useful to maintain sinus rh...
...tion is reasonable in patients with CTI-de...
...ation of the CTI is reasonable in...
...blation is reasonable in patients with...
...cainide or propafenone may be considered to mainta...
...r ablation may be reasonable for asymptomatic pa...
...11. Ongoing Management of Atrial...
...nctional Tachycardi...
...cute Treatment of Junctional Tachy...
...kers are reasonable for acute treatment...
...iltiazem, procainamide, or verapam...
...oing Management of Junctional Tachycard...
...al beta blockers are reasonable for ong...
...diltiazem or verapamil is reasonab...
...propafenone may be reasonable for...
...tion may be reasonable in patients with ju...
...re 12. Ongoing Management of Junct...
...CHD
...19. Acute Treatment of AC...
...ithrombotic therapy is recommended in ACHD pati...
...d cardioversion is recommended for...
...diltiazem or esmolol (with extra caut...
...osine is recommended for acute treat...
...butilide or procainamide can be effe...
...l pacing can be effective for acute treatment...
...lective synchronized cardioversion can...
...dofetilide or sotalol may be reasonable fo...
...re 13. Acute Treatment of SVT in ACHD Patients...
...20. Ongoing Management of ACHD...
...nt with antithrombotic therapy is reco...
...ent of associated hemodynamic abnormalities...
...catheter ablation or intraoperative...
...lockers or sotalol therapy can be useful for pr...
...er ablation is reasonable for treat...
Surgical ablation of AT or atrial flutter can...
...may be reasonable to decrease recurrences...
...ilide may be reasonable for prevention of...
...miodarone may be reasonable for pr...
...de should not be administered for tre...
...oing Management of SVT in ACHD Patients...
...le 21. Acute Treatment of SVT in Preg...
...uvers are recommended for acute tre...
...denosine is recommended for acute...
...dioversion is recommended for acute treatment in...
...olol or propranolol is reasonable for acute...
...y be reasonable for acute treatment in pr...
...de may be reasonable for acute treat...
...y be considered for acute treatment in pregnant...
...T in Pregnan...
...22. Ongoing Management of SVT in Pregnancy
...g drugs, alone or in combination, can be effecti...
...tion may be reasonable in pregnant patients with...
...rone may be considered for ongoing managem...
...VT in Older Populatio...
...ute Treatment of SVT in Older Populations...
...ic and therapeutic approaches to SVT should be ind...