Supraventricular Tachycardia Clinical Practice

Guidelines (2019)
reference.medscape.com

The recommendations on the management of supraventricular tachycardia (SVT) were

released in August 2019 by the European Society of Cardiology (ESC) in collaboration with
the Association for European Paediatric and Congenital Cardiology (AEPC).[1,2] Several
changes from the previous guidelines (2003) include revised drug grades as well as
medications that are no longer considered, and changes to ablation techniques and
indications.

Table. Medications, Strategies, and Techniques Speci ed or Not Mentioned in the 2019
Guidelines

Type of Treatment (Grade) Not Mentioned in 2019 Guidelines

Tachycardia
Narrow QRS Verapamil and diltiazem; Amiodarone, digoxin
tachycardias beta-blockers (now all are
grade IIa)
Wide QRS Procainamide, adenosine Sotalol, lidocaine
tachycardias (both grade IIa);
amiodarone (IIb)
Inappropriate Beta-blockers (IIa) Verapamil/diltiazem, catheter
sinus ablation
tachycardia
Postural Salt and uid intake (IIb) Head-up tilt sleep, compression
orthostatic stockings, selective beta-blockers,
tachycardia udrocortisone, clonidine,
syndrome methylphenidate, uoxetine,
erythropoietin, ergotaminel
octreotide, phenobarbitone
Focal atrial Acute: beta-blockers (IIa); Acute: procainamide, sotalol,
tachycardia ecainide/propafenone, digoxin
amiodarone (IIb)
Chronic: beta-blockers; Chronic: amiodarone, sotalol,
verapamil and diltiazem disopyramide
 (all IIa)
Atrial utter Acute: ibutilide (I); Acute: digitalis
verapamil and diltiazem,
beta-blockers (all IIa);
atrial or transesophageal
pacing (IIb);
ecainide/propafenone
(III)
Chronic: — Chronic: dofetilide, sotalol,
ecainide, propafenone,
procainamide, quinidine,
disopyramide
Atrioventricular Acute: — Acute: amiodarone, sotalol,
nodal re- ecainide, propafenone
entrant Chronic: verapamil and Chronic: amiodarone, sotalol,
tachycardia diltiazem; beta-blockers ecainide, propafenone, “pill-in-the-
(AVNRT) (all IIa) pocket” approach
Atrioventricular Beta-blockers (IIa); Amiodarone, sotalol, “pill-in-the-
re-entrant ecainide/propafenone pocket” approach
tachycardia (IIb)
(AVRT)
SVT in Verapamil (IIa); catheter Sotalol, propafenone, quinidine,
pregnancy ablation (IIa when procainamide
uoroless ablation is
available)
Adapted from Brugada J, Katritsis DG, Arbelo E, et al, for the ESC Scienti c
Document Group. 2019 ESC Guidelines for the management of patients with
supraventricular tachycardia. The Task Force for the management of patients
with supraventricular tachycardia of the European Society of Cardiology (ESC).
Eur Heart J. 2019 Aug 31;ehz467.
https://academic.oup.com/eurheartj/advance-
article/doi/10.1093/eurheartj/ehz467/5556821

2019 New Recommendations

For detailed recommendations on speci c types of SVTs, please consult the original
guidelines as listed under the references.

Class I (recommended or indicated)

For conversion of atrial utter: Intravenous (IV) ibutilide, or IV or oral (PO) (in-hospital)
dofetilide

For termination of atrial utter (when an implanted pacemaker or de brillator is present):

High-rate atrial pacing

For asymptomatic patients with high-risk features (eg, shortest pre-excited RR interval
during atrial brillation [SPERRI] ≤250 ms, accessory pathway [AP] effective refractory
period [ERP] ≤250 ms, multiple APs, and an inducible AP-mediated tachycardia) as identi ed
on electrophysiology testing (EPS) using isoprenaline: Catheter ablation

For tachycardia responsible for tachycardiomyopathy that cannot be ablated or controlled

by drugs: Atrioventricular nodal ablation followed by pacing (“ablate and pace”)
(biventricular or His-bundle pacing)

First trimester of pregnancy: Avoid all antiarrhythmic drugs, if possible

Class IIa (should be considered)

Symptomatic patients with inappropriate sinus tachycardia: Consider ivabradine alone or

with a beta-blocker

Atrial utter without atrial brillation: Consider anticoagulation (initiation threshold not yet
established)

Asymptomatic preexcitation: Consider EPS for risk strati cation

Asymptomatic preexcitation with left ventricular dysfunction due to electrical dyssynchrony:

Consider catheter ablation

Class IIb (may be considered)

Acute focal atrial tachycardia: Consider IV ibutilide

Chronic focal atrial tachycardia: Consider ivabradine with a beta-blocker

Postural orthostatic tachycardia syndrome: Consider ivabradine

Asymptomatic preexcitation: Consider noninvasive assessment of the AP conducting

properties
Asymptomatic preexcitation with low-risk AP at invasive/noninvasive risk strati cation:
Consider catheter ablation

Prevention of SVT in pregnant women without Wolff-Parkinson-White syndrome: Consider

beta-1 selective blockers (except atenolol) (preferred) or verapamil

Prevention of SVT in pregnant women with Wolff-Parkinson-White syndrome and without

ischemic or structural heart disease: Consider ecainide or propafenone

Class III (not recommended)

IV amiodarone is not recommended for preexcited atrial brillation.

For more information, please go to Atrial Tachycardia, Atrial Fibrillation, Atrial Flutter, and
Atrioventricular Nodal Reentry Tachycardia.

For more Clinical Practice Guidelines, please go to Guidelines.