ESC Guidelines Updated for Supraventricular Tachycardia

In guidelines developed by the European Society of Cardiology, in collaboration with the Association for European Paediatric and Congenital Cardiology, updated recommendations are presented for the management of patients with supraventricular tachycardia (SVT). The guidelines were published online Aug. 31 in the European Heart Journal to coincide with the European Society of Cardiology Congress 2019, held from Aug. 31 to Sept. 4 in Paris.

Josep Brugada, M.D., Ph.D., from the University of Barcelona in Spain, and colleagues updated the 2003 guidelines for management of patients with SVT.

The authors note that techniques and indications for ablation techniques have changed. According to the recommendations, for symptomatic patients with inappropriate sinus tachycardia, ivabradine should be considered alone or in combination with a beta-blocker. For acute therapy of focal atrial tachycardia, ibutilide may be considered. For conversion of atrial flutter, ibutilide or dofetilide are recommended. For asymptomatic patients in whom electrophysiology testing identifies high-risk properties, catheter ablation is recommended; catheter ablation should also be considered for patients with asymptomatic pre-excitation and a low-risk accessory pathway at invasive or noninvasive risk stratification and for patients with asymptomatic pre-excitation and left ventricular dysfunction due to electrical dyssynchrony. If a tachycardia responsible for tachycardiomyopathy cannot be ablated or controlled by drugs, atrioventricular nodal ablation with subsequent pacing is recommended. All antiarrhythmic drugs should be avoided during the first trimester of pregnancy, if possible.

"Catheter ablation techniques and technology have evolved in a way that we can now offer this treatment modality to most of our patients with SVT," a coauthor said in a statement.

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