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
...eneral Principles
...levant Terms and DefinitionsHaving...
Diagnosis
...iagnosi...
...1. Differential Diagnosis for Adult Narr...
Treatment
...eatment...
...Treatment of SVT of Unknown Mechanis...
...rs are recommended for acute treatme...
...is recommended for acute treatment i...
...cardioversion is recommended for acute treatment...
...cardioversion is recommended for acute trea...
IV diltiazem or verapamil can be effective f...
...rs are reasonable for acute treatment i...
...lors in tables and figures correspond to...
...ure 2. Acute Treatment of SVT of Unknow...
...ble 3. Ongoing Management of SVT of...
...ckers, diltiazem, or verapamil is usefu...
...tudy with the option of ablation is useful for th...
...ents with SVT should be educated on how to perf...
...ainide or propafenone is reasonable for ongo...
...ol may be reasonable for ongoing management in...
...ide may be reasonable for ongoing mana...
...amiodarone may be considered for ongoing...
...al digoxin may be reasonable for ongoing...
...ure 3. Ongoing Management of SVT of Unknown Mec...
...STa
...ngoing Management of IST...
...aluation for and treatment of reversible ca...
...radine is reasonable for ongoing managem...
...rs may be considered for ongoing management in...
...combination of beta blockers and ivabradine...
...pecific recommendations for acute treatment o...
...Focal AT and MAT
...e 5. Acute Treatment of Suspected Foc...
...lockers, diltiazem, or verapamil is useful for a...
...cardioversion is recommended for acu...
...sine can be useful in the acute setting to...
...arone may be reasonable in the acute...
...ay be reasonable in the acute setting to restor...
...ure 4. Acute Treatment of Suspected Focal AT...
...Management of Suspected Focal AT...
...ablation is recommended in patients...
...l beta blockers, diltiazem, or verap...
...inide or propafenone can be effective fo...
...amiodarone may be reasonable for...
...ure 5. Ongoing Management of Focal A...
...e 7. Acute Treatment o...
...ol or verapamil can be useful for acute treatm...
...ble 8. Ongoing Management of...
Oral verapamil (IIa, B-NR)5...
...tiazem (IIa, C-LD)...
...easonable for ongoing management in patients wi...
...ure 6. Acute Treatment of...
...able 9. Acute Treatment...
...s are recommended for acute treatment in patients...
...is recommended for acute treatment in patients w...
Synchronized cardioversion should be performed for...
...chronized cardioversion is recommended for acute...
...ockers, diltiazem, or verapamil are r...
...a blockers, diltiazem, or verapamil may be reaso...
...V amiodarone may be considered for acute treatment...
Figure 7. Ongoing Managem...
.... Ongoing Management of AVNRT...
...l or diltiazem is recommended for ongoing manag...
...tion of the slow pathway is recommended in pat...
...ta blockers are recommended for ongoing mana...
Flecainide or propafenone is reasonabl...
Clinical follow-up without pharmacological therapy...
...talol or dofetilide may be reasonable for ongoi...
...digoxin or amiodarone may be reasonable for on...
...ed (“pill-in-the-pocket”) acute doses of or...
...ifest or Concealed Accessory Pathwa...
...Acute Treatment of Orthodromic AVR...
Vagal maneuvers are recommended for acute...
...e is beneficial for acute treatment in patients...
...rdioversion should be performed for...
...ynchronized cardioversion is recommended for acute...
...chronized cardioversion should be p...
...IV procainamide is beneficial for acute tre...
...diltiazem, verapamil (IIa,...
...r beta blockers (IIa, C-LD)...
...rs, diltiazem, and verapamil might be cons...
...amiodarone , IV or oral beta bloc...
...Acute Treatment of Orthodromic AVRT...
...2. Ongoing Management of Orthodromic AVR...
...heter ablation of the accessory pat...
...eta blockers, diltiazem, or verapamil are indica...
...e or propafenone is reasonable for ongoing manage...
...e or sotalol may be reasonable for...
...rone may be considered for ongoing ma...
...ral beta blockers, diltiazem, or verapamil may be...
...goxin may be reasonable for ongoing...
...ral digoxin is potentially harmful...
.... Ongoing Management of Orthodromic AV...
...symptomatic Pre-Exc...
.... Asymptomatic Patients With Pre-Excitation...
In asymptomatic patients with pre-excitatio...
...t loss of conduction over a manifest pathway duri...
...mittent loss of pre-excitation during ECG or...
...s reasonable in asymptomatic patients...
...heter ablation of the accessory pathwa...
...ablation of the accessory pathway i...
...servation, without further evaluation or treatment...
...recommendations have been designated wit...
...able 14. Risk Stratification of Symptomatic P...
...ngs of abrupt loss of conduction over the...
or intermittent loss of pre-excitation...
...P study is useful in symptomatic patients with...
...trial Flutt...
.... Acute Treatment of Atrial F...
...ilide or IV ibutilide is useful for acu...
...al beta blockers, diltiazem, or ver...
...onized cardioversion is indicated in stable pati...
...nchronized cardioversion is recommended for acute...
...id atrial pacing is useful for acute conver...
...ute antithrombotic therapy is recommended...
...can be useful for acute control of the ventric...
...10. Acute Treatment of Atrial Flutter...
...16. Ongoing Management of Atrial F...
...ablation of the CTI is useful in p...
...eta blockers, diltiazem, or verapamil a...
...tion is useful in patients with recurrent...
...ng management with antithrombotic...
...ollowing drugs can be useful to main...
...er ablation is reasonable in patients with CTI...
...ablation of the CTI is reasonable...
...lation is reasonable in patients with recurre...
...ainide or propafenone may be considered to m...
...heter ablation may be reasonable for asymptomat...
...1. Ongoing Management of Atrial Flutter...
...tional Tachycardia...
.... Acute Treatment of Junctional Tach...
...eta blockers are reasonable for acute...
...diltiazem, procainamide, or verapami...
...18. Ongoing Management of Junctional Ta...
...blockers are reasonable for ongoing management i...
...l diltiazem or verapamil is reasonable for ong...
...r propafenone may be reasonable for ongoi...
...tion may be reasonable in patients w...
...oing Management of Junctional Tachycardia...
...CHD
...19. Acute Treatment of ACHD
...otic therapy is recommended in ACHD pat...
...ynchronized cardioversion is recomme...
...or esmolol (with extra caution using either age...
...adenosine is recommended for acute treatment...
...or procainamide can be effective for a...
...g can be effective for acute treatment...
Elective synchronized cardioversion can b...
...de or sotalol may be reasonable for acute treat...
...3. Acute Treatment of SVT in ACHD Patients...
...20. Ongoing Management of ACH...
...management with antithrombotic ther...
...of associated hemodynamic abnormalities for...
Preoperative catheter ablation or intrao...
...beta blockers or sotalol therapy can b...
...lation is reasonable for treatment of recurre...
Surgical ablation of AT or atrial flutter c...
...ay be reasonable to decrease recurrences of...
...ilide may be reasonable for prevention of rec...
...e may be reasonable for prevention o...
...should not be administered for treatment...
...Ongoing Management of SVT in ACHD Patients...
...Treatment of SVT in Pregnancy...
...uvers are recommended for acute treatment in pre...
...recommended for acute treatment in pregnant patien...
...dioversion is recommended for acute treatm...
...ol or propranolol is reasonable for a...
...pamil may be reasonable for acute treatmen...
...V procainamide may be reasonable for acut...
...ay be considered for acute treatment...
...T in Pregnanc...
...22. Ongoing Management of SVT in Pr...
...lowing drugs, alone or in combination, can be...
...tion may be reasonable in pregnant patients w...
...amiodarone may be considered for on...
...lder Populations...
...te Treatment of SVT in Older Populations...
...therapeutic approaches to SVT should be i...