New ESC Guidelines on SVT Management: “Catheter ablation is key”

It is of great importance to note that – according to the new (2019) Guidelines for the Management of SVT’s – catheter ablation is considered as a first line of treatment.

PARIS — Catheter ablation has been placed front and center in the latest guidelines for the management of supraventricular tachycardia (SVT) from the European Society of Cardiology (ESC). The guidelines also refine the use of drug therapy for the condition and make important recommendations for pregnant women.

Moreover, the guidelines have dropped a whole host of medications that were once considered part of standard care for managing this family of arrhythmic conditions.” – Medscape, ESC Conference News

https://www.medscape.com/viewarticle/917569

A_ESC_Guidelines_for_Management_Supraventricular_Tachyc_EurHeartJ

Latest SVT guidelines (Adapted from ESC 2019, Prof Hugh Calkins, member from the Guideline Writing Group)

(1) Catheter ablation is the preferred initial treatment strategy for almost all patients with symptomatic SVTs, with the exception of pregnant patients in the first trimester and also patients with inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome, and multifocal atrial tachycardia.

(2) Start with vagal manoeuvres and adenosine in the acute evaluation and management of patients with sustained forms of SVT.

(3) Catheter ablation is recommended for treatment of patients with tachycardia-induced cardiomyopathy

(4) Patients with both atrial flutter and AF should be anticoagulated according to the AF anticoagulation guidelines.

(5) Catheter ablation can be considered for patients with asymptomatic pre-excitation who have ‘low risk’ APs provided the procedure is performed at an experienced centre and after careful consideration of the patient’s preferences.

(6) Patients with asymptomatic pre-excitation who are competitive athletes should undergo EPS with isoproterenol for risk stratification. If a ‘high risk’ AP is identified catheter ablation is recommended.

(7) Patients with pre-excitation who are asymptomatic and who are not competitive athletes may consider either an EPS for risk stratification (Class 2A, LOE B), or non-invasive risk stratification (Class 2B, LOE C).

(8) Supraventricular tachycardias may present as a wide complex tachycardia due to concomitant BBB, drug-induced conduction slowing, antegrade conduction of an AP, or an atrial sensed ventricular paced rhythm. Despite this fact, wide complex tachycardias should be considered to be caused by ventricular tachycardia until proved otherwise.

(9) Cardioversion is the preferred initial treatment strategy for SVT patients who are haemodynamically unstable only.

(10) Avoid antiarrhythmic drugs during the first trimester of pregnancy.

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Source:
https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2019/09/10/12/36/2019-esc-guidelines-for-supraventricular-tachycardia

Download the Complete ECS 2019 Guidelines on SVT Management

https://academic.oup.com/eurheartj/article/41/5/655/5556821

https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Supraventricular-Tachycardia

Read the full text in PDF format