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.
