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

...l Principles...

...nt Terms and DefinitionsHaving trouble viewing ta...


Diagnosis

Diagnosi...

...fferential Diagnosis for Adult Narrow QRS Tachyca...


Treatment

...reatment

...ute Treatment of SVT of Unknown Me...

...al maneuvers are recommended for acute trea...

Adenosine is recommended for acute treatment i...

...hronized cardioversion is recommended for acut...

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

...diltiazem or verapamil can be effective for...

...blockers are reasonable for acute treatme...

...s in tables and figures correspond to Class...


.... Acute Treatment of SVT of Unknown Mechanism...


...Management of SVT of Unknown Mecha...

...rs, diltiazem, or verapamil is useful for...

EP study with the option of ablation is u...

...h SVT should be educated on how to perform v...

...inide or propafenone is reasonable for ongoing m...

...reasonable for ongoing management in patients...

...tilide may be reasonable for ongoi...

...odarone may be considered for ongoing manage...

...may be reasonable for ongoing management in p...


.... Ongoing Management of SVT of Unknown Mech...


ISTa

...4. Ongoing Management of IS...

Evaluation for and treatment of reversible causes...

Ivabradine is reasonable for ongoing...

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

...bination of beta blockers and ivabradine may be...

...specific recommendations for acute treatme...


...inus Focal AT and MAT

...Acute Treatment of Suspected Focal A...

...ta blockers, diltiazem, or verapamil is...

...onized cardioversion is recommended...

...n be useful in the acute setting to either re...

...miodarone may be reasonable in the a...

...lide may be reasonable in the acute setti...


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


...going Management of Suspected Focal AT...

...ablation is recommended in patient...

...ta blockers, diltiazem, or verapamil...

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

...amiodarone may be reasonable for ongoing...


...e 5. Ongoing Management of Focal AT...


...e 7. Acute Treatment of...

...l or verapamil can be useful for acute treatm...


Table 8. Ongoing Management...

...rapamil (IIa, B-NR)573...

...tiazem (IIa, C-LD)5...

...toprolol is reasonable for ongoing management in...


...igure 6. Acute Treatmen...


...Acute Treatment of AVNRT...

Vagal maneuvers are recommended for acute t...

...commended for acute treatment in pa...

...cardioversion should be performed for acut...

...ynchronized cardioversion is recommend...

...ckers, diltiazem, or verapamil are r...

...rs, diltiazem, or verapamil may be reasonable for...

...ay be considered for acute treatment in...


...7. Ongoing Management of AVNRT...


...Ongoing Management of AVNRT...

...pamil or diltiazem is recommended...

...on of the slow pathway is recommended...

...beta blockers are recommended for ongoi...

...nide or propafenone is reasonable for o...

...ical follow-up without pharmacological therapy or...

...or dofetilide may be reasonable for o...

...l digoxin or amiodarone may be reasonable...

...nistered (“pill-in-the-pocket”) acute doses of...


...Manifest or Concealed Accessory Pathway...

...Acute Treatment of Orthodromic AVRT...

...maneuvers are recommended for acute...

...neficial for acute treatment in patients...

...nchronized cardioversion should be performed fo...

...nchronized cardioversion is recomm...

...onized cardioversion should be perfo...

...tilide or IV procainamide is beneficial...

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

or beta blockers (IIa, C-LD)57...

...beta blockers, diltiazem, and verapamil...

...oxin, IV amiodarone , IV or oral beta...

Figure 8. Acute Treatment of Orthodr...

...Ongoing Management of Orthodromic AVRT...

...er ablation of the accessory pathway is recommend...

...eta blockers, diltiazem, or verapamil ar...

...de or propafenone is reasonable for ongoing m...

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

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

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

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

...potentially harmful for ongoing managemen...

...oing Management of Orthodromic AVRT...


...tic Pre-Excitation...

...13. Asymptomatic Patients With Pre-Exci...

...matic patients with pre-excitation...

...brupt loss of conduction over a manife...

...ttent loss of pre-excitation during EC...

...is reasonable in asymptomatic patients with p...

...tion of the accessory pathway is reasonable in...

...theter ablation of the accessory pathway is rea...

...n, without further evaluation or t...

...ndations have been designated with the...

...k Stratification of Symptomatic Patients With Mani...

...of abrupt loss of conduction over...

...ittent loss of pre-excitation during EC...

...useful in symptomatic patients with pre-excit...


...al Flutter...

...5. Acute Treatment of Atrial Flu...

...fetilide or IV ibutilide is useful for...

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

...ynchronized cardioversion is indicated i...

Synchronized cardioversion is recomm...

...pid atrial pacing is useful for ac...

...hrombotic therapy is recommended in patients with...

...arone can be useful for acute control of the v...

...ute Treatment of Atrial Flutter...

...ble 16. Ongoing Management of Atrial Flutter

...n of the CTI is useful in patients with atrial...

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

...theter ablation is useful in patients wi...

...management with antithrombotic therapy is...

...following drugs can be useful to maintain sinus...

Catheter ablation is reasonable in patient...

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

...ablation is reasonable in patients...

...opafenone may be considered to maint...

...eter ablation may be reasonable for asymptomat...

Figure 11. Ongoing Management of A...


Junctional Tachyca...

...le 17. Acute Treatment of Junctional Tachycardia...

...ers are reasonable for acute treatme...

...procainamide, or verapamil is reasonable...

...18. Ongoing Management of Junctional Tachycard...

...blockers are reasonable for ongoing management...

...iltiazem or verapamil is reasonable for ongoing m...

...ropafenone may be reasonable for ongoing man...

...er ablation may be reasonable in patients wit...

...ng Management of Junctional Tachycardia...


ACHD

...e 19. Acute Treatment of AC...

...e antithrombotic therapy is recommended in ACHD...

...ynchronized cardioversion is recomm...

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

...recommended for acute treatment in AC...

...ibutilide or procainamide can be effecti...

...ng can be effective for acute treatment in ACHD p...

...ronized cardioversion can be useful for...

...lide or sotalol may be reasonable for acute...

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

...20. Ongoing Management of ACHD

...ent with antithrombotic therapy is recommen...

...of associated hemodynamic abnormalities f...

...theter ablation or intraoperative surgical a...

...beta blockers or sotalol therapy can be...

...blation is reasonable for treatment of recurren...

...n of AT or atrial flutter can be effective in ACH...

...cing may be reasonable to decrease...

...may be reasonable for prevention of recurre...

...ne may be reasonable for preventio...

...hould not be administered for treatment...

...gure 14. Ongoing Management of SVT in...

...ute Treatment of SVT in Pregnancy...

...al maneuvers are recommended for a...

...denosine is recommended for acute treatment in p...

...ardioversion is recommended for acute tr...

IV metoprolol or propranolol is reasonabl...

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

...cainamide may be reasonable for acute treatment in...

...miodarone may be considered for acute tre...


...in Pregnanc...

...2. Ongoing Management of SVT in...

...he following drugs, alone or in combination,...

...er ablation may be reasonable in p...

...odarone may be considered for ongoing man...


...in Older Populations

...e 23. Acute Treatment of SVT in Older...

...c and therapeutic approaches to SVT should be...