Supraventricular tachycardia AHA recommendations for Management of SVT of Unknown Mechanism
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Aysha Anwar, M.B.B.S[2]
Overview
The AHA 2015 recommendations for Management of SVT of unknown mechanism include vagal maneuvers, adenosine, intravenous diltiazem or verapamil, intravenous beta blockers, oral beta blockers, diltiazem, or verapamil, flecainide or propafenone and synchronized cardioversion.
Management of SVT of Unknown Mechanism
Recommendations for management of SVT of unknown mechanism are desccibed below:[1]
Recommendations for Acute Treatment of SVT of Unknown Mechanism
| Class I |
| "1. Vagal maneuvers are recommended for acute treatment in patients with regular SVT.[2][3][4] (Level of Evidence: B-R) " |
| "2. Adenosine is recommended for acute treatment in patients with regular SVT.[3][5][6][7][8][9][10][11][12](Level of Evidence: B-R) " |
| "3. Synchronized cardioversion is recommended for acute treatment in patients with hemodynamically unstable SVT when vagal maneuvers or adenosine are ineffective or not feasible.[13] (Level of Evidence: B-NR) " |
| "4. Synchronized cardioversion is recommended for acute treatment in patients with hemodynamically stable SVT when pharmacological therapy is ineffective or contraindicated.[5] "(Level of Evidence: B-NR) " |
| Class IIa |
| "1. Intravenous diltiazem or verapamil can be effective for acute treatment in patients with hemodynamically stable SVT "(Level of Evidence:B-R) " |
| "2. Intravenous beta blockers are reasonable for acute treatment in patients with hemodynamically stable SVT "(Level of Evidence: C-LD) " |
Recommendations for Ongoing Management of SVT of Unknown Mechanism
| Class I |
| "1. Oral beta blockers, diltiazem, or verapamil is useful for ongoing management in patients with symptomatic SVT who do not have ventricular pre-excitation during sinus rhythm(Level of Evidence: B-R) " |
| "2. Electrophysiological (EP) study with the option of ablation is useful for the diagnosis and potential treatment of SVT (Level of Evidence: B-NR) " |
| "3. Patients with SVT should be educated on how to perform vagal maneuvers for ongoing management of SVT (Level of Evidence: C-LD) " |
| Class IIa |
| "1. Flecainide or propafenone is reasonable for ongoing management in patients without structural heart disease or ischemic heart disease who have symptomatic SVT and are not candidates for, or prefer not to undergo, catheter ablation(Level of Evidence:B-R) " |
| Class IIb |
| "1. Sotalol may be reasonable for ongoing management in patients with symptomatic SVT who are not candidates for, or prefer not to undergo, catheter ablation (Level of Evidence:B-R) " |
| "2. Dofetilidemay be reasonable for ongoing management in patients with symptomatic SVT who are not candidates for, or prefer not to undergo, catheter ablation and in whom beta blockers, diltiazem, flecainide, propafenone, or verapamil are ineffective or contraindicated (Level of Evidence:B-R) " |
| "3. Oral amiodarone may be considered for ongoing management in patients with symptomatic SVT who are not candidates for, or prefer not to undergo, catheter ablation and in whom beta blockers, diltiazem, dofetilide, flecainide, propafenone, sotalol, or verapamil are ineffective or contraindicated (Level of Evidence: C-LD) " |
| "4. Oral digoxin may be reasonable for ongoing management in patients with symptomatic SVT without pre-excitation who are not candidates for, or prefer not to undergo, catheter ablation(Level of Evidence: C-LD) " |
References
- ↑ Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ; et al. (2016). "2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society". J Am Coll Cardiol. 67 (13): e27–e115. doi:10.1016/j.jacc.2015.08.856. PMID 26409259.
- ↑ Lim SH, Anantharaman V, Teo WS, Goh PP, Tan AT (1998). "Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage". Ann Emerg Med. 31 (1): 30–5. PMID 9437338.
- ↑ 3.0 3.1 Wang CL, Miyata T, Schlear S, Weksler B, Rubin AL, Stenzel KH (1975). "Collagen and glomerular basement membrane effects on platelets". Trans Am Soc Artif Intern Organs. 21: 422–6. PMID 1146016.
- ↑ Waxman MB, Wald RW, Sharma AD, Huerta F, Cameron DA (1980). "Vagal techniques for termination of paroxysmal supraventricular tachycardia". Am J Cardiol. 46 (4): 655–64. PMID 7416025.
- ↑ 5.0 5.1 Brady WJ, DeBehnke DJ, Wickman LL, Lindbeck G (1996). "Treatment of out-of-hospital supraventricular tachycardia: adenosine vs verapamil". Acad Emerg Med. 3 (6): 574–85. PMID 8727628.
- ↑ Cairns CB, Niemann JT (1991). "Intravenous adenosine in the emergency department management of paroxysmal supraventricular tachycardia". Ann Emerg Med. 20 (7): 717–21. PMID 2064090.
- ↑ Gausche M, Persse DE, Sugarman T, Shea SR, Palmer GL, Lewis RJ; et al. (1994). "Adenosine for the prehospital treatment of paroxysmal supraventricular tachycardia". Ann Emerg Med. 24 (2): 183–9. PMID 8037382.
- ↑ Madsen CD, Pointer JE, Lynch TG (1995). "A comparison of adenosine and verapamil for the treatment of supraventricular tachycardia in the prehospital setting". Ann Emerg Med. 25 (5): 649–55. PMID 7741343.
- ↑ McCabe JL, Adhar GC, Menegazzi JJ, Paris PM (1992). "Intravenous adenosine in the prehospital treatment of paroxysmal supraventricular tachycardia". Ann Emerg Med. 21 (4): 358–61. PMID 1554170.
- ↑ Rankin AC, Oldroyd KG, Chong E, Rae AP, Cobbe SM (1989). "Value and limitations of adenosine in the diagnosis and treatment of narrow and broad complex tachycardias". Br Heart J. 62 (3): 195–203. PMC 1216762. PMID 2789911.
- ↑ Lim SH, Anantharaman V, Teo WS (2002). "Slow-infusion of calcium channel blockers in the emergency management of supraventricular tachycardia". Resuscitation. 52 (2): 167–74. PMID 11841884.
- ↑ DiMarco JP, Miles W, Akhtar M, Milstein S, Sharma AD, Platia E; et al. (1990). "Adenosine for paroxysmal supraventricular tachycardia: dose ranging and comparison with verapamil. Assessment in placebo-controlled, multicenter trials. The Adenosine for PSVT Study Group". Ann Intern Med. 113 (2): 104–10. PMID 2193560.
- ↑ Roth A, Elkayam I, Shapira I, Sander J, Malov N, Kehati M; et al. (2003). "Effectiveness of prehospital synchronous direct-current cardioversion for supraventricular tachyarrhythmias causing unstable hemodynamic states". Am J Cardiol. 91 (4): 489–91. PMID 12586276.