Three major cardiology societies released a new guideline on Sept. 23 to manage adults with all types of supraventricular tachycardia (SVT) other than atrial fibrillation.
The American College of Cardiology (ACC), American Heart Association (AHA) and Heart Rhythm Society (HRS) recommended patient preferences and clinical judgment should be taken into account when determining the best treatment options. Therapeutic choices include ablation, observation and medications such as oral beta blockers, diltiazem, verapamil, flecainide, propafenone, amiodarone, dofetilide, sotalol or digoxin.
The researchers suggested that treatments should be considered based on the frequency and duration of SVT as well as symptoms or adverse consequences. They examined regular narrow–QRS complex tachycardias, atrial flutter with irregular ventricular response, multifocal atrial tachycardia and other types of SVT.
“Shared decision making is especially important for patients with SVT,” they wrote. “As seen in this guideline, SVT treatment can be nuanced and requires expert knowledge of [electrophysiology] processes and treatment options. Treatment options are highly specific to the exact type of arrhythmia and can depend on certain characteristics of a particular arrhythmia. The various choices for therapy, including drugs, cardioversion, invasive treatment, or a combination thereof, can be confusing to the patient, so a detailed explanation of the benefits and risks must be included in the conversation.”
Although a small number of studies have found catheter ablation was more cost effective than medical therapy in treating SVT and atrial flutter, the researchers did not provide cost effective recommendations because the studies were based on cost data and practice patterns that do not apply to the current environment and practice.
The prevalence of SVT is 2.29 per 1,000 people. Women are two times more likely than men to develop the condition, while people older than 65 are at five times the risk of developing SVT, which is usually diagnosed in the emergency room. Physicians typically use a 12-lead electrocardiogram during tachycardia and sinus rhythm to determine the cause of tachycardia.
The evidence review included literature published through September 2014. The guideline writing committee gathered the studies by searching MEDLINE, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality and other databases. The committee also reviewed documents related to SVT that were published by the ACC, AHA and HRS.
The guideline writing committee included clinicians, cardiologists and electrophysiologists, a nurse and representatives from the ACC, AHA and HRS.
An independent evidence review committee consisting of methodologists, epidemiologists, clinicians and biostatisticians assessed the evidence and reviewed important clinical questions.
“The overall goal of the guideline is to provide clinicians with the tools needed to successfully diagnose and treat patients with supraventricular tachycardia upon presentation in the inpatient or outpatient setting,” Richard L. Page, MD, FACC, FAHA, FHRS, chair of the department of medicine at the University of Wisconsin and chair of the writing committee, said in a news release. “This includes quick diagnosis and treatment, making any necessary referrals to cardiology and electrophysiology specialists, discussion and collaboration with the patient, and the prescription of appropriate treatment.”