Investigators Present New Supraventricular Tachycardia Guidelines at ESC

Josep Brugada, MD, PhD

New guidelines available at the European Society of Cardiology (ESC) in Paris call for catheter ablation as a recommended treatment for supraventricular tachycardia (SVT).

While drug therapies for SVT have not changed much since the last set of guidelines were published in 2003, Josep Brugada, MD, PhD, Chairperson of the guidelines Task Force and professor of medicine, University of Barcelona, explained why an update is necessary after 16 years.

“We do have more data on the potential benefits and risks associated with several drugs, and we know how to use them in a safer way,” Brugada said in a statement. “In addition, some new antiarrhythmic drugs are available.”

The main update is related to the availability of more efficient and safe invasive methods to eradicate the arrhythmia through catheter ablation, a therapy that uses heat or freezing to destroy the heart tissue that causes the arrhythmia.

Professor Demosthenes Katritsis, MD, PhD, Chairperson of the guidelines Task Force and director of the 3rd Cardiology Department, Hygeia Hospital, Athens, explained the benefits of using catheter ablation.

"Catheter ablation techniques and technology have evolved in a way that we can now offer this treatment modality to most of our patients with SVT," Katritsis said in a statement.

Catheter ablation is the most effective therapy to maintain sinus rhythm, according to the guidelines, resulting in a less than 10% rate of recurrence.

The process of developing the ESC Guidelines included the creation of educational tools and the implementation of programs for the recommendations including condensed pocket guideline versions, summary slides, booklets with essential messages, summary cards for non-specialists, and an electronic version for digital applications.

The guideline includes several treatments downgraded from recommended to should be or may be considered, such as verapamil for acute management of narrow QRS tachycardias, procainamide and amiodarone for acute management of wide QRS tachycardias, and beta-blockers for therapy of inappropriate sinus tachycardia.

Other medications were upgraded and should be recommended, included ibutilide for therapy of atrial flutter.

SVT is characterized by a heart rate above 100 beats per minute due to a fault with the electric system that controls the heart’s rhythm, impacting approximately .2% of the general population. Woman are particularly affected by SVT, with a risk that is 2 times greater than men. People who are older than 65 also have a 5 times greater risk of developing SVT than younger people.

SVT’s generally start and stop suddenly, arising in the atria and the conduction system above the ventricles. They are rarely life-threatening in the acute phase, but if left untreated could affect the heart’s function, increase the risk of stroke, and affect the patient’s quality of life.

Symptoms of SVT often include palpitations, fatigue, light-headedness, chest discomfort, shortness of breath, and altered consciousness.

Antiarrhythmic drugs are particularly useful for acute episodes, but not as beneficial for long-term treatment due to their relatively low efficacy and related side-effects.

The guideline also suggest pregnant women avoid all antiarrhythmic drugs within the first trimester of their pregnancy with only a select few drugs to be used with caution.

The guidelines also call for athletes with frequent supraventricular arrhythmias should be assessed to exclude the presence of an underlying cardiac disease, electrolyte imbalance, thyroid dysfunction, and the use of stimulants or performance-enhancing drugs.

The study, "2019 ESC Guidelines for the management of patients with supraventricular tachycardia," was published online in the European Heart Journal.