AHA GUIDELINES Bundle (free trial)

Supraventricular Tachycardia

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Key Points ÎThe writing committee generated a clinical practice guideline that provides for high-quality, evidence-based decision making for patients with SVT. ÎThe "2015 ACC/AHA/HRS Guideline for the Management of Adult Patients with Supraventricular Tachycardia" replaces the "2003 ACC/AHA/ESC Guidelines for the Management of Patients with Supraventricular Arrhythmias". It utilizes new knowledge from clinical trials, treatments and drugs, and updates or replaces recommendations. ÎAtrial fibrillation is not included in this guideline. ÎShared decision making is stressed in the document with attention to the patient's preferences and treatment goals and their individual situations. ÎThe best available evidence indicates that the prevalence of SVT in the general population is 2.29 per 1,000 persons, and the incidence of PSVT is estimated to be 36 per 100,000 persons per year. ÎWomen have twice the risk of men of developing PSVT. Individuals >65 years of age have >5 times the risk of younger persons of developing PSVT. ÎSVT has an impact on quality of life, which varies according to the frequency of episodes, the duration of SVT, and whether symptoms occur not only with exercise but also at rest. ÎWhile drug therapy is largely unchanged from 2003, there is one exception. Ivabradine is a new class of drug that has unique properties for reduction of the heart rate. The guideline provides new recommendations for use of ivabradine for ongoing management in patients with inappropriate sinus tachycardia. ÎAblation techniques have improved, including techniques to minimize radiation exposure. As such, catheter ablation may be reasonable in pregnant patients with highly symptomatic, recurrent, drug-refractory SVT with efforts toward minimizing radiation exposure. ÎThis guideline also provides new recommendations for the management of patients with asymptomatic WPW pattern, based on a systematic review of the evidence. General Principles Table 1. Relevant Terms and Definitions Arrhythmia/Term Definition Supraventricular tachycardia (SVT) An umbrella term used to describe tachycardias (atrial and/or ventricular rates in excess of 100 bpm at rest), the mechanism of which involves tissue from the His bundle or above. ese SVTs include IST, AT (including focal and multifocal AT), macroreentrant AT (including typical atrial flutter), junctional tachycardia, AVNRT, and various forms of accessory pathway- mediated reentrant tachycardias. In this guideline, the term does not include AF.

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