Supraventricular tachycardia AHA recommendations for Management of SVT in ACHD Patients
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Supraventricular tachycardia Microchapters |
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Differentiating Among the Different Types of Supraventricular Tachycardia |
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Differentiating Supraventricular Tachycardia from Ventricular Tachycardia |
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Treatment |
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2015 ACC/AHA Guideline Recommendations |
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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
[Synchronized cardioversion]] is recommended for acute treatment in ACHD patients and SVT who are hemodynamically unstable. Acute antithrombotic therapy is recommended in ACHD patients who have AT or atrial flutter to align with recommended antithrombotic therapy for patients with AF. Intravenous diltiazem or esmolol (with extra caution used for either agent, observing for the development of hypotension) is recommended for acute treatment in ACHD patients and SVT who are hemodynamically stable. Intravenous adenosine is recommended for acute treatment in ACHD patients and SVT. Ongoing management with antithrombotic therapy is recommended in ACHD patients and AT or atrial flutter to align with recommended antithrombotic therapy for patients with AF. Assessment of associated hemodynamic abnormalities for potential repair of structural defects is recommended in ACHD patients as part of therapy for SVT. Flecainide should not be administered for treatment of SVT in ACHD patients and significant ventricular dysfunction.[1]
Management of SVT in ACHD (Adult Congenital heart disease) Patients
2015 AHA recommendations for the acute and ongoing management of SVT in ACHD (Adult Congenital heart disease) patients are described below:[1]
Acute Treatment of SVT in ACHD Patients
| Class I |
| "1. Acute antithrombotic therapy is recommended in ACHD patients who have AT or atrial flutter to align with recommended antithrombotic therapy for patients with AF"(Level of Evidence:C-LD ) " |
| "2. Synchronized cardioversion is recommended for acute treatment in ACHD patients and SVT who are hemodynamically unstable "(Level of Evidence:B-NR ) " |
| "3. Intravenous diltiazem or esmolol (with extra caution used for either agent, observing for the development of hypotension) is recommended for acute treatment in ACHD patients and SVT who are hemodynamically stable "(Level of Evidence:C-LD ) " |
| "4. Intravenous adenosine is recommended for acute treatment in ACHD patients and SVT "(Level of Evidence:B_NR ) " |
| Class IIa |
| "1. Intravenous ibutilide or procainamide can be effective for acute treatment in ACHD patients and atrial flutter who are hemodynamically stable "(Level of Evidence:B_NR) " |
| "2. Atrial pacing can be effective for acute treatment in ACHD patients and SVT who are hemodynamically stable and anticoagulated as per current guidelines for antithrombotic therapy in patients with AF "(Level of Evidence:B_NR) " |
| "3. Elective synchronized cardioversion can be useful for acute termination of AT or atrial flutter in ACHD patients when acute pharmacological therapy is ineffective or contraindicated "(Level of Evidence:B_NR ) " |
| Class IIb |
| "1. Oral dofetilide or sotalol may be reasonable for acute treatment in ACHD patients and AT and/or atrial flutter who are hemodynamically stable"(Level of Evidence:B-NR) " |
Management of ongoing SVT in ACHD Patients
| Class I |
| "1. Ongoing management with antithrombotic therapy is recommended in ACHD patients and AT or atrial flutter to align with recommended antithrombotic therapy for patients with AF"(Level of Evidence:C-LD ) " |
| "2. Assessment of associated hemodynamic abnormalities for potential repair of structural defects is recommended in ACHD patients as part of therapy for SVT"(Level of Evidence:C-LD ) " |
| Class IIa |
| "1. Preoperative catheter ablation or intraoperative surgical ablation of accessory pathways or AT is reasonable in patients with SVT who are undergoing surgical repair of Ebstein anomaly "(Level of Evidence:B-NR ) " |
| "2. Oral beta blockers or sotalol therapy can be useful for prevention of recurrent AT or atrial flutter in ACHD patients "(Level of Evidence:B-NR ) " |
| "3. Catheter ablation is reasonable for treatment of recurrent symptomatic SVT in ACHD patients "(Level of Evidence:B-NR ) " |
| "4. Surgical ablation of AT or atrial flutter can be effective in ACHD patients undergoing planned surgical repair "(Level of Evidence:B-NR ) " |
| Class IIb |
| "1. Atrial pacing may be reasonable to decrease recurrences of AT or atrial flutter in ACHD patients and sinus node dysfunction "(Level of Evidence:B-NR) " |
| "2. Oral dofetilide may be reasonable for prevention of recurrent AT or atrial flutter in ACHD patients "(Level of Evidence:B-NR) " |
| "3. Amiodarone may be reasonable for prevention of recurrent AT or atrial flutter in ACHD patients for whom other medications and catheter ablation are ineffective or contraindicated "(Level of Evidence:B-NR) "
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| Class III |
| "1. Flecainide should not be administered for treatment of SVT in ACHD patients and significant ventricular dysfunction "(Level of Evidence:B-NR) " |
References
- ↑ 1.0 1.1 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.