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ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019) www.escardio.org/guidelines 1 2019 ESC Guidelines for the management of patients with supraventricular tachycardia Task Force Members: Josep Brugada (Chairperson) (Spain), Demosthenes G. Katritsis (Chairperson) (Greece), Elena Arbelo (Spain), Fernando Arribas (Spain), Jeroen J. Bax (Netherlands), Carina Blomström-Lundqvist (Sweden), Hugh Calkins (United States of America), Domenico Corrado (Italy), Spyridon G. Deftereos (Greece), Gerhard-Paul Diller (Germany), Juan J. Gomez-Doblas (Spain), Bulent Gorenek (Turkey), Andrew Grace (United Kingdom), Siew Yen Ho (United Kingdom), Juan-Carlos Kaski (United Kingdom), Karl-Heinz Kuck (Germany), Pier David Lambiase (United Kingdom), Frederic Sacher (France), Georgia Sarquella-Brugada 1 (Spain), Piotr Suwalski (Poland), Antonio Zaza (Italy) 1 Representing the Association for European Paediatric and Congenital Cardiology (AEPC)

2019 ESC Guidelines on Supraventricular Tachycardias

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Page 1: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines 1

2019 ESC Guidelines for the management of patients with supraventricular tachycardiaTask Force Members:Josep Brugada (Chairperson) (Spain), Demosthenes G. Katritsis (Chairperson) (Greece), Elena Arbelo (Spain), Fernando Arribas (Spain), Jeroen J. Bax (Netherlands), Carina Blomström-Lundqvist (Sweden), Hugh Calkins (United States of America), Domenico Corrado (Italy), Spyridon G. Deftereos (Greece), Gerhard-Paul Diller (Germany), Juan J. Gomez-Doblas (Spain), Bulent Gorenek (Turkey), Andrew Grace (United Kingdom), Siew Yen Ho (United Kingdom), Juan-Carlos Kaski (United Kingdom), Karl-Heinz Kuck (Germany), Pier David Lambiase (United Kingdom), Frederic Sacher (France), Georgia Sarquella-Brugada1 (Spain), Piotr Suwalski (Poland), Antonio Zaza (Italy)

1 Representing the Association for European Paediatric and Congenital Cardiology (AEPC)

Page 2: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines 2

Page 3: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Average success and complications rates of catheter ablation for supraventricular tachycardia

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SVT prevalence: 2.25/1000 persons 

SVT incidence: 35/100 000 person-years 

2019 ESC Guidelines for the management of patients with supraventricular tachycardia

Page 4: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Acute therapy of narrow QRS tachycardia in the absence of an established diagnosis

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Changes in recommendations since 2003

Page 5: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Acute therapy of wide complex tachycardia in the absence of an established diagnosis

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Changes in recommendations since 2003

Page 6: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Therapy of sinus tachycardia

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POTS

Salt and fluid intake IIa IIb

Head-up tilt sleep, compression stockings, selective beta-blockers, fludrocortisone, clonidine, methylphenidate, fluoxetine, erythropoietin, ergotamine/octreotide, and phenobarbitone are not mentioned in the 2019 guidelines.

Changes in recommendations since 2003

Page 7: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Acute therapy of focal atrial tachycardia

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Changes in recommendations since 2003

Page 8: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Chronic therapy of focal atrial tachycardia

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Changes in recommendations since 2003

Page 9: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Acute therapy of stable atrial flutter/macro-

re-entrant atrial tachycardia

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Changes in recommendations since 2003

Page 10: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Chronic therapy of atrial flutter/macro-re-entrant atrial 

tachycardia

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Changes in recommendations since 2003

Page 11: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Acute therapy of AVNRT

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Changes in recommendations since 2003

Page 12: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Chronic therapy of AVNRT

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Changes in recommendations since 2003

Page 13: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Acute therapy of AVRT

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Amiodarone, sotalol, and the ‘pill-in-the pocket’approach are not mentioned in the 2019 Guidelines

Changes in recommendations since 2003

Page 14: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Chronic therapy of AVRT

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Page 15: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Acute therapy of pre-excited AF

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No drug therapy recommendations provided in 2003

Page 16: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Risk stratification and therapy of patients with asymptomatic pre-

excitation

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Not provided in 2003

Page 17: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Recommendations for the therapy SVT in pregnancy

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Recommendations Classa Levelb

Catheter ablation is recommended in symptomatic women with recurrent SVT who plan to become pregnant.

I C

Chronic therapy

During the first trimester of pregnancy it is recommended to avoid all antiarrhythmic drugs, if possible.

I C

Fluoroless catheter ablation should be considered in case of drug-refractory or poorly tolerated SVT, in experienced centres.

IIa C

Page 18: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Recommendations for the therapy of SVT in patients with suspected or established heart failure due to tachycardiomyopathy

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It is recommended to consider tachycardiomyopathy in patient

with reduced LVEF with an elevated heart rate (>100 bpm). I B

24 h (or multi-day) ambulatory ECG monitoring should be

considered for diagnosis of tachycardiomyopathy by

identifying subclinical or intermittent arrhythmias.IIa B

Recommendations Classa Levelb

Page 19: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

Recommendations for the therapy of SVT in patients with suspected or established heart failure due to tachycardiomyopathy

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AV nodal ablation with subsequent pacing (“ablate and pace”) either biventricular

or His-bundle pacing, is recommended if the tachycardia responsible for the

tachycardiomyopathy cannot be ablated or controlled by drugs.

I C

Recommendations Classa Levelb

Catheter ablation is recommended for tachycardiomyopathy due to SVT. I B

Beta-blockers (from the list with proven mortality and morbidity benefits in HFrEF)

are recommended for tachycardiomyopathy due to SVT, when catheter ablation fails

or is not applicable.

I A

Page 20: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

‘What to do’ messages from the Guidelines

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Page 21: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

20 Evidence-based ‘what to do’ and ‘what not to do’ messages from the Guidelines

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Page 22: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

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‘What not to do’ messages from the Guidelines

Page 23: 2019 ESC Guidelines on Supraventricular Tachycardias

ESC Guidelines for the management of patients with supraventricular Tachycardia (European Heart Journal; 2019)www.escardio.org/guidelines

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‘What not to do’ messages from the Guidelines