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
...ral Principles...
...ant Terms and DefinitionsHaving tro...
Diagnosis
...iagnosi...
...e 1. Differential Diagnosis for Adult Narrow QRS T...
Treatment
Treatme...
...Treatment of SVT of Unknown Mechanism...
...al maneuvers are recommended for acute treatmen...
...is recommended for acute treatment in p...
...nchronized cardioversion is recommended for ac...
...zed cardioversion is recommended for...
...iazem or verapamil can be effective for acute t...
...blockers are reasonable for acute treat...
...and figures correspond to Class of Recomme...
...ute Treatment of SVT of Unknown Mechan...
...3. Ongoing Management of SVT of Unknown Mechanis...
...kers, diltiazem, or verapamil is u...
...with the option of ablation is usef...
Patients with SVT should be educated o...
...r propafenone is reasonable for ongoin...
...may be reasonable for ongoing managem...
Dofetilide may be reasonable for ongoing man...
...l amiodarone may be considered for o...
...al digoxin may be reasonable for ongoing manageme...
...ure 3. Ongoing Management of SVT of...
IST...
...e 4. Ongoing Management of IST...
...and treatment of reversible causes are recommend...
Ivabradine is reasonable for ongoing manageme...
...lockers may be considered for ongoing man...
...of beta blockers and ivabradine may be co...
...are no specific recommendations for acute trea...
...us Focal AT and MAT...
...Treatment of Suspected Focal AT...
...ockers, diltiazem, or verapamil is useful for acut...
...cardioversion is recommended for...
...ne can be useful in the acute setting to...
...arone may be reasonable in the acute setting...
...may be reasonable in the acute setti...
.... Acute Treatment of Suspected Focal AT...
...ble 6. Ongoing Management of Susp...
...r ablation is recommended in patients with...
...a blockers, diltiazem, or verapamil are reasonable...
Flecainide or propafenone can be effectiv...
...otalol or amiodarone may be reason...
...5. Ongoing Management of Fo...
...Acute Treatment of MAT
...lol or verapamil can be useful for...
...Ongoing Management of...
...verapamil (IIa, B-NR)57...
...tiazem (IIa, C-LD)57...
...oprolol is reasonable for ongoing management in pa...
...gure 6. Acute Treatment of AVN...
Table 9. Acute Treatment...
...vers are recommended for acute treatment i...
Adenosine is recommended for acute treatment...
...nized cardioversion should be perform...
...onized cardioversion is recommended for acute...
...kers, diltiazem, or verapamil are reasonable...
...lockers, diltiazem, or verapamil may be reasonab...
IV amiodarone may be considered for...
...7. Ongoing Management of AVNRT...
...10. Ongoing Management o...
...erapamil or diltiazem is recommende...
...eter ablation of the slow pathway is...
...blockers are recommended for ongoing mana...
...r propafenone is reasonable for ongo...
...ollow-up without pharmacological the...
...sotalol or dofetilide may be reasonabl...
...amiodarone may be reasonable for ong...
...-administered (“pill-in-the-pocket...
...omatic Manifest or Concealed Accesso...
Table 11. Acute Treatment of Orthodromic...
...s are recommended for acute treatme...
...s beneficial for acute treatment in pat...
...nchronized cardioversion should be...
Synchronized cardioversion is recommen...
...cardioversion should be performed for...
...lide or IV procainamide is benefici...
...m, verapamil (IIa, B-R)573...
...a blockers (IIa, C-LD)573...
...rs, diltiazem, and verapamil might be considered...
...igoxin, IV amiodarone , IV or oral beta blo...
.... Acute Treatment of Orthodromic...
...e 12. Ongoing Management of Orthodromic AV...
...ablation of the accessory pathway is...
Oral beta blockers, diltiazem, or verapami...
...de or propafenone is reasonable for ongo...
...etilide or sotalol may be reasonable...
...may be considered for ongoing management i...
...eta blockers, diltiazem, or verapami...
...digoxin may be reasonable for ongoing ma...
...in is potentially harmful for ongoing management...
...igure 9. Ongoing Management of Orthodr...
...ymptomatic Pre-Excitat...
...Asymptomatic Patients With Pre-Excitation...
...omatic patients with pre-excitation, the...
abrupt loss of conduction over a manife...
...t loss of pre-excitation during ECG or ambula...
...tudy is reasonable in asymptomatic patients...
...on of the accessory pathway is reason...
...lation of the accessory pathway is re...
...hout further evaluation or treatment, is...
...ndations have been designated with the notation SR...
...able 14. Risk Stratification of Sympto...
...abrupt loss of conduction over the p...
...loss of pre-excitation during ECG o...
...tudy is useful in symptomatic patients with p...
Atrial Flutte...
...Acute Treatment of Atrial Flutter...
...de or IV ibutilide is useful for acute pha...
...blockers, diltiazem, or verapamil a...
...ctive synchronized cardioversion i...
...d cardioversion is recommended for ac...
...acing is useful for acute conversion of...
...e antithrombotic therapy is recommended i...
...amiodarone can be useful for acute con...
...10. Acute Treatment of Atrial...
...16. Ongoing Management of Atrial Flutter...
...r ablation of the CTI is useful in...
...s, diltiazem, or verapamil are useful to...
...ation is useful in patients with recurrent sympt...
...ngoing management with antithrombotic therapy i...
...ollowing drugs can be useful to maintain s...
...ation is reasonable in patients wi...
...atheter ablation of the CTI is reasonable in pa...
...ter ablation is reasonable in patients w...
...ropafenone may be considered to maintain sinu...
...eter ablation may be reasonable for asy...
...Ongoing Management of Atrial Flutter...
...tional Tachycardia...
...able 17. Acute Treatment of Junctional Tach...
...are reasonable for acute treatment in patien...
...m, procainamide, or verapamil is reason...
...ble 18. Ongoing Management of Junctional Tachy...
...beta blockers are reasonable for ongoing ma...
Oral diltiazem or verapamil is reasonable...
...inide or propafenone may be reasonable...
...heter ablation may be reasonable in patients wi...
...12. Ongoing Management of Junctional Tachy...
ACHD
...e 19. Acute Treatment of ACHD...
...ute antithrombotic therapy is recom...
...dioversion is recommended for acute treatment i...
...zem or esmolol (with extra caution...
...adenosine is recommended for acute treatment...
...ilide or procainamide can be effective for acute...
...acing can be effective for acute tre...
...hronized cardioversion can be usefu...
...ide or sotalol may be reasonable for acute treatm...
...Acute Treatment of SVT in ACHD Pat...
.... Ongoing Management of ACHD...
...ing management with antithrombotic therapy i...
...ssment of associated hemodynamic abnormalities...
...rative catheter ablation or intraope...
...blockers or sotalol therapy can be useful for...
...ion is reasonable for treatment of r...
...al ablation of AT or atrial flutter ca...
...trial pacing may be reasonable to decrease r...
...ral dofetilide may be reasonable fo...
...ne may be reasonable for prevention of recur...
...cainide should not be administered for trea...
...Ongoing Management of SVT in ACHD Patie...
...Acute Treatment of SVT in Pregnancy...
...l maneuvers are recommended for ac...
...is recommended for acute treatment in preg...
...chronized cardioversion is recommended for acute...
...toprolol or propranolol is reasonable fo...
IV verapamil may be reasonable for acute...
...ide may be reasonable for acute treatment i...
...V amiodarone may be considered for...
...in Pregnancy...
...22. Ongoing Management of SVT in Pre...
...owing drugs, alone or in combination, can b...
Catheter ablation may be reasonable in preg...
...darone may be considered for ongoin...
...Older Populations
...3. Acute Treatment of SVT in Older Po...
...agnostic and therapeutic approaches to SV...