What are the ESC/AEPC guidelines for the management of supraventricular tachycardia?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
  • Print
Answer

Supraventricular Tachycardia Clinical Practice Guidelines (2019)

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. [36, 37]

Table. Medications, Strategies, and Techniques Specified or Not Mentioned in the 2019 Guidelines (Open Table in a new window)

Type of Tachycardia

Treatment (Grade)

Not Mentioned in 2019 Guidelines

Narrow QRS tachycardias

Verapamil and diltiazem; beta-blockers (now all are grade IIa)

Amiodarone, digoxin

Wide QRS tachycardias

Procainamide, adenosine (both grade IIa); amiodarone (IIb)

Sotalol, lidocaine

Inappropriate sinus tachycardia

Beta-blockers (IIa)

Verapamil/diltiazem, catheter ablation

Postural orthostatic tachycardia syndrome

Salt and fluid intake (IIb)

Head-up tilt sleep, compression stockings, selective beta-blockers, fludrocortisone, clonidine, methylphenidate, fluoxetine, erythropoietin, ergotaminel octreotide, phenobarbitone

Focal atrial tachycardia

Acute: beta-blockers (IIa); flecainide/propafenone, amiodarone (IIb)

Acute: procainamide, sotalol, digoxin

Chronic: beta-blockers; verapamil and diltiazem (all IIa)

Chronic: amiodarone, sotalol, disopyramide

Atrial flutter

Acute: ibutilide (I); verapamil and diltiazem, beta-blockers (all IIa); atrial or transesophageal pacing (IIb); flecainide/propafenone (III)

Acute: digitalis

Chronic:

Chronic: dofetilide, sotalol, flecainide, propafenone, procainamide, quinidine, disopyramide

Atrioventricular nodal re-entrant tachycardia (AVNRT)

Acute:

Acute: amiodarone, sotalol, flecainide, propafenone

Chronic: verapamil and diltiazem; beta-blockers (all IIa)

Chronic: amiodarone, sotalol, flecainide, propafenone, “pill-in-the-pocket” approach

Atrioventricular re-entrant tachycardia (AVRT)

Beta-blockers (IIa); flecainide/propafenone (IIb)

Amiodarone, sotalol, “pill-in-the-pocket” approach

SVT in pregnancy

Verapamil (IIa); catheter ablation (IIa when fluoroless ablation is available)

Sotalol, propafenone, quinidine, procainamide

Adapted from Brugada J, Katritsis DG, Arbelo E, et al, for the ESC Scientific 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


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!