Ongoing Management of Patients With Supraventricular Tachycardia

GUIDELINE TITLE 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia DEVELOPER ACC/AHA/HRS RELEASE DATES September 23, 2015 (online); April 5, 2016 (print) PRIOR VERSION October 14, 2003 FUNDING SOURCE ACC/AHA/HRS TARGET POPULATION Adults with SVT MAJOR RECOMMENDATIONS This guideline presents recommendations for the management of SVT. Consistent with previous guidelines, the document does not include AF. This synopsis focuses on recommendations for the ongoing management of SVT. In patients with symptomatic SVT (in the absence of ventricular preexcitation during sinus rhythm), chronic use of oral beta blockers, diltiazem, or verapamil is useful (moderate-quality evidence). Flecainide and propafenone are reasonably effective (moderate-quality evidence) as a second-line therapy in patients without structural or ischemic heart disease when ablation is not an option, is not preferred by the patient, or is unsuccessful. In patients with inappropriate sinus tachycardia, ongoing treatment with ivabradine can be effective (moderate-quality evidence). As ivabradine is newly approved this is a new recommendation. Chronic treatment with oral verapamil (moderate-quality evidence), diltiazem (low-quality evidence), or metoprolol (low-quality evidence) is reasonably effective for patients with recurrent symptomatic multifocal atrial tachycardia. Catheter ablation of the slow pathway is recommended (moderate-quality evidence) in patients with AVNRT. If ablation is not appropriate or preferred by the patient, then oral verapamil, diltiazem, or a beta blocker is recommended (moderate quality evidence). Flecainide or propafenone are also reasonably effective (moderate-quality evidence) for the ongoing management of patients with AVNRT who have no structural or ischemic heart disease. Catheter ablation of the accessory pathway is recommended (moderate-quality evidence) for patients with AVRT and/or pre-excited AF. If catheter ablation is not appropriate or preferred by the patient, an oral beta blocker, diltiazem, or verapamil is indicated (low-quality evidence) when pre-excitation is not present on the resting ECG. Flecainide or propafenone are also reasonably effective (moderate-quality evidence) for patients with AVRT who have no structural or ischemic heart disease. Catheter ablation of the cavotricuspid isthmus is effective (moderate-quality evidence) for patients with an atrial flutter that is either symptomatic or difficult to rate-control. A beta blocker, diltiazem, or verapamil is effective (low-quality evidence) in controlling the ventricular rate in patients with hemodynamically-tolerated atrial flutter. In patients with symptomatic, recurrent atrial flutter, amiodarone, dofetilide, and sotalol can be effective with the medication choice depending on the presence of heart disease and comorbidities.