Материал: 2019 ESC - supraventricular tachycardia
ESC GUIDELINES
European Heart Journal (2019) 00, 1 65 doi:10.1093/eurheartj/ehz467
2019 ESC Guidelines for the management of patients with supraventricular tachycardia
The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC)
Developed in collaboration with the Association for European Paediatric and Congenital Cardiology (AEPC)
Authors/Task Force Members: Josep Brugada* (Chairperson) (Spain), Demosthenes G. Katritsis* (Chairperson) (Greece), Elena Arbelo (Spain), Fernando Arribas (Spain), Jeroen J. Bax (Netherlands),
Carina Blomstro¨m-Lundqvist (Sweden), Hugh Calkins (United States of America), Domenico Corrado (Italy), Spyridon G. Deftereos (Greece), Gerhard-Paul Diller (Germany), Juan J. Gomez-Doblas (Spain), Bulent Gorenek (Turkey), Andrew Grace (United Kingdom), Siew Yen Ho (United Kingdom), Juan-Carlos Kaski (United Kingdom), Karl-Heinz Kuck (Germany), Pier David Lambiase (United Kingdom), Frederic Sacher (France), Georgia Sarquella-Brugada1 (Spain),
Piotr Suwalski (Poland), Antonio Zaza (Italy)
* Corresponding authors: Josep Brugada, Cardiology Department, Hospital Clinic, and Pediatric Arrhythmia Unit, Hospital Sant Joan de De´u, University of Barcelona, Spain. Tel: þ34 3460 902 2351, Fax: þ34 3493 227 1777, Email: jbrugada@clinic.cat.
Demosthenes G. Katritsis, Department of Cardiology, Hygeia Hospital, E. Stavrou 4, 15123 Athens, Greece, Tel: þ30 6944 845 505, Fax: þ30 210 6722535, Email: dkatrits@dgkatritsis.gr.
Author/Task Force Member Affiliations: listed in the Appendix.
ESC CPG and National Cardiac Societies document reviewers: listed in the Appendix.
1Representing the AEPC.
ESC entities having participated in the development of this document:
Associations: Acute Cardiovascular Care Association (ACCA), European Association of Cardiovascular Imaging (EACVI), European Association of Preventive Cardiology (EAPC), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA).
Councils: Council for Cardiology Practice.
Working Groups: Cardiac Cellular Electrophysiology, Cardiovascular Pharmacotherapy, Cardiovascular Surgery, Development Anatomy and Pathology, Grown-up Congenital Heart Disease.
The content of these ESC Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC (journals.permissions@oxfordjournals.org).
Disclaimer: The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
VC The European Society of Cardiology and the European Atherosclerosis Association 2019. All rights reserved.
For permissions please email: journals.permissions@oup.com.
2019 September 13 on guest by 1093/eurheartj/ehz467/5556821.abstract/doi/10-article-com/eurheartj/advance.oup.https://academic from Downloaded
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ESC Guidelines |
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Document Reviewers: Tom De Potter [Committee for Practice Guidelines (CPG) Review Coordinator] (Belgium), Christian Sticherling (CPG Review Coordinator) (Switzerland), Victor Aboyans (France), Cristina Basso (Italy), Mario Bocchiardo (Italy), Werner Budts (Belgium), Victoria Delgado (Netherlands), Dobromir Dobrev (Germany), Donna Fitzsimons (United Kingdom), Sofie Gevaert (Belgium), Hein Heidbuchel (Belgium), Gerhard Hindricks (Germany), Peter Hlivak (Slovakia),
Prapa Kanagaratnam (United Kingdom), Hugo Katus (Germany), Josef Kautzner (Czech Republic), Thomas Kriebel1 (Germany), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil Lewis (Israel), Yury Lopatin (Russian Federation), Be´ la Merkely (Hungary), Thomas Paul (Germany), Nikola Pavlovic (Croatia), Steffen Petersen (United Kingdom),
Anna Sonia Petronio (Italy), Tatjana Potpara (Serbia), Marco Roffi (Switzerland), Daniel Scherr (Austria), Evgeny Shlyakhto (Russian Federation), Iain A. Simpson (United Kingdom), Katja Zeppenfeld (Netherlands)
The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines
For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the Guidelines see https://academic.oup.com/eurheartj/article-lookup/doi/ 10.1093/eurheartj/ehz467#supplementary-data
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Keywords |
Guidelines • arrhythmia • tachycardia • supraventricular • flutter • atrioventricular • re-entrant • focal |
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• macro re-entrant • junctional • nodal • pre-excitation • ablation |
Table of contents |
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1 Preamble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
5 |
2 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
7 |
2.1 Evidence review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
7 |
2.2 Relationships with industry and other conflicts of interest . . . . . . |
7 |
2.3 What is new in the 2019 Guidelines? . . . . . . . . . . . . . . . . . . . . . . . . . . |
7 |
2.3.1 Change in recommendations from 2003 to 2019 . . . . . . . . . . |
7 |
2.3.2 New recommendations in 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . |
8 |
2.3.3 New revised concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
8 |
3 Definitions and classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
8 |
4 Electrophysiological mechanisms of supraventricular |
|
tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
9 |
5 Cardiac anatomy for the electrophysiologist . . . . . . . . . . . . . . . . . . . . . . |
10 |
6 Epidemiology of supraventricular tachycardia . . . . . . . . . . . . . . . . . . . . . |
10 |
7 Clinical presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
10 |
8 Initial evaluation of patients with supraventricular tachycardia . . . . . . |
11 |
9 Differential diagnosis of tachycardias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
11 |
9.1 Narrow QRS (=120 ms) tachycardias . . . . . . . . . . . . . . . . . . . . . . . . |
11 |
9.1.1 Electrocardiographic differential diagnosis . . . . . . . . . . . . . . . . |
11 |
9.1.1.1 Initiation and termination of the tachycardia . . . . . . . . . . . . |
11 |
9.1.1.2 Regularity of tachycardia cycle length . . . . . . . . . . . . . . . . . . |
11 |
9.1.1.3 P/QRS relationship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
11 |
9.1.2 Vagal manoeuvres and adenosine . . . . . . . . . . . . . . . . . . . . . . . . |
13 |
9.1.3 Electrophysiology study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
14 |
9.2 Wide QRS (>120 ms) tachycardias . . . . . . . . . . . . . . . . . . . . . . . . . . . |
14 |
9.2.1 Electrocardiographic differential diagnosis . . . . . . . . . . . . . . . . |
14 |
9.2.1.1 Atrioventricular dissociation . . . . . . . . . . . . . . . . . . . . . . . . . . . |
14 |
9.2.1.2 QRS duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
14 |
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9.2.1.3 QRS axis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 14 |
9.2.1.4 Chest lead concordance . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 14 |
9.2.1.5 Right bundle branch block morphology . . . . . . . . . . . . . |
. . . . 15 |
9.2.1.6 Left bundle branch block morphology . . . . . . . . . . . . . . |
. . . . 15 |
9.2.2 Electrophysiology study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 16 |
9.3 Irregular tachycardias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 16 |
10 Acute management in the absence of an established diagnosis |
. . . . 16 |
10.1 Regular tachycardias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 16 |
10.1.1 Narrow QRS (=120 ms) tachycardias . . . . . . . . . . . . . . . |
. . . . 16 |
10.1.1.1 Haemodynamically unstable patients . . . . . . . . . . . . |
. . . . 16 |
10.1.1.2 Haemodynamically stable patients . . . . . . . . . . . . . . . |
. . . . 16 |
10.1.2 Wide QRS (>120 ms) tachycardias . . . . . . . . . . . . . . . . . |
. . . . 18 |
10.1.2.1 Haemodynamically unstable patients . . . . . . . . . . . . |
. . . . 18 |
10.1.2.2 Haemodynamically stable patients . . . . . . . . . . . . . . . |
. . . . 18 |
10.2 Irregular tachycardias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 19 |
11 Specific types of supraventricular tachycardia . . . . . . . . . . . . . . . . |
. . . . 19 |
11.1 Atrial arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 19 |
11.1.1 Sinus tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 19 |
11.1.1.1 Physiological sinus tachycardia . . . . . . . . . . . . . . . . . . . |
. . . . 19 |
11.1.1.2 Inappropriate sinus tachycardia . . . . . . . . . . . . . . . . . . |
. . . . 19 |
11.1.1.2.1 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 19 |
11.1.1.2.2 Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 19 |
11.1.1.3 Sinus node re-entrant tachycardia . . . . . . . . . . . . . . . . |
. . . . 20 |
11.1.1.3.1 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 20 |
11.1.1.3.2 Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 20 |
11.1.1.4 Postural orthostatic tachycardia syndrome . . . . . . . . |
. . . . 20 |
11.1.1.4.1 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 20 |
11.1.1.4.2 Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 21 |
11.1.2 Focal atrial tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
. . . . 21 |
2019 September 13 on guest by 1093/eurheartj/ehz467/5556821.abstract/doi/10-article-com/eurheartj/advance.oup.https://academic from Downloaded
ESC Guidelines |
3 |
11.1.2.1 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
21 |
11.1.2.2 Acute therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
21 |
11.1.2.3 Catheter ablation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
21 |
11.1.2.4 Chronic therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
23 |
11.1.3 Multifocal atrial tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
24 |
11.1.3.1 Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
24 |
11.1.4 Macro-re-entrant atrial tachycardias . . . . . . . . . . . . . . . . . . . . |
24 |
11.1.4.1 Cavotricuspid isthmus-dependent |
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macro-re-entrant atrial tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . |
24 |
11.1.4.1.1 Typical atrial flutter: common |
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(counter-clockwise) and reverse (clockwise) . . . . . . . . . . . . |
24 |
11.1.4.1.2 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
24 |
11.1.4.1.3 Acute therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
25 |
11.1.4.1.4 Catheter ablation . . . . . . . . . . . . . . . . . . . . . . . . . |
27 |
11.1.4.1.5 Chronic therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . |
27 |
11.1.4.1.6 Anticoagulation . . . . . . . . . . . . . . . . . . . . . . . . . . . |
27 |
11.1.4.1.7 Other cavotricuspid isthmus-dependent |
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macro-re-entrant atrial tachycardia . . . . . . . . . . . . . . . . . . . |
27 |
11.1.4.2 Non-cavotricuspid isthmus-dependent |
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macro-re-entrant atrial tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . |
27 |
11.1.4.2.1 Right atrium macro-re-entrant atrial |
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tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
27 |
11.1.4.2.2 Left atrium macro-re-entrant atrial |
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tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
28 |
11.2 Atrioventricular junctional arrhythmias . . . . . . . . . . . . . . . . . . . . . . |
29 |
11.2.1 Atrioventricular nodal re-entrant tachycardia . . . . . . . . . . . |
29 |
11.2.1.1 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
29 |
11.2.1.1.1 12 lead electrocardiogram during |
|
tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
29 |
11.2.1.1.2 Electrophysiology study . . . . . . . . . . . . . . . . . . . . |
30 |
11.2.1.1.3 Typical atrioventricular nodal |
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re-entrant tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
30 |
11.2.1.1.4 Atypical atrioventricular nodal |
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re-entrant tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
30 |
11.2.1.2 Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
30 |
11.2.1.2.1 Acute therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
31 |
11.2.1.2.2 Catheter ablation . . . . . . . . . . . . . . . . . . . . . . . . . |
31 |
11.2.1.2.3 Chronic therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . |
31 |
11.2.2 Non-re-entrant junctional tachycardias . . . . . . . . . . . . . . . . . |
32 |
11.3 Atrioventricular arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
32 |
11.3.1 Accessory pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
32 |
11.3.2 WolffParkinsonWhite syndrome . . . . . . . . . . . . . . . . . . . . . . . |
33 |
11.3.3 Orthodromic atrioventricular re-entrant tachycardia . . . . |
33 |
11.3.4 Antidromic atrioventricular re-entrant tachycardia . . . . . . |
34 |
11.3.5 Accessory pathway as a bystander . . . . . . . . . . . . . . . . . . . . . . |
34 |
11.3.6 Pre-excited atrial fibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
34 |
11.3.7 Concealed accessory pathways . . . . . . . . . . . . . . . . . . . . . . . . . |
34 |
11.3.8 Permanent junctional reciprocating tachycardia . . . . . . . . . . |
35 |
11.3.9 Atypical forms of pre-excitation . . . . . . . . . . . . . . . . . . . . . . . . |
35 |
11.3.10 Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
36 |
11.3.10.1 Acute therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
36 |
11.3.10.2 Catheter ablation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
38 |
11.3.10.3 Chronic therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
38 |
11.3.11 The asymptomatic patient with pre-excitation . . . . . . . . . |
38 |
12 Supraventricular tachycardia in adults with congenital heart |
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disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
41 |
12.1 Pharmacological antiarrhythmic therapy . . . . . . . . . . . . . . . . . . . . . |
41 |
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12.2 Catheter and surgical ablation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
42 |
12.3 Specific disease states . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
42 |
12.3.1 Atrial septal defect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
42 |
12.3.2 Ebstein’s anomaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
42 |
12.3.3 Transposition of the great arteries (dextro-transposition |
|
of the great arteries) after atrial switch operation |
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(Mustard or Senning) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
42 |
12.3.4 Tetralogy of Fallot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
43 |
12.3.5 Fontan repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
43 |
13 Supraventricular tachycardia in the paediatric population . . . . . . . . . |
43 |
13.1 Foetal arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
43 |
14 Supraventricular tachycardia in pregnancy . . . . . . . . . . . . . . . . . . . . . . . |
43 |
14.1 Maternal, obstetric, and offspring risk . . . . . . . . . . . . . . . . . . . . . . . . |
44 |
14.2 Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
44 |
14.2.1 Antiarrhythmic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
44 |
14.2.2 Electrical cardioversion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
45 |
14.2.3 Catheter ablation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
45 |
15 Tachycardia-induced cardiomyopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . |
45 |
15.1 Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
45 |
15.2 Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
45 |
15.3 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
45 |
15.4 Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
45 |
16 Supraventricular tachycardia in sports . . . . . . . . . . . . . . . . . . . . . . . . . . . |
46 |
17 Supraventricular tachycardia and driving restrictions . . . . . . . . . . . . . |
46 |
18 Key messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
47 |
19 Gaps in the evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
47 |
20 Evidence-based ‘what to do’ and ‘what not to do’ messages |
|
from the Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
48 |
21 Areas for further research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
49 |
22 Supplementary data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
50 |
23 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
50 |
24 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
51 |
Recommendations |
|
Recommendations for the acute management of narrow QRS |
|
tachycardia in the absence of an established diagnosis . . . . . . . . . . . . . . . |
16 |
Recommendations for the acute management of wide QRS |
|
tachycardia in the absence of an established diagnosis . . . . . . . . . . . . . . . |
18 |
Recommendations for the therapy of sinus tachycardias . . . . . . . . . . . . . |
20 |
Recommendations for the therapy of focal atrial tachycardia . . . . . . . . . |
22 |
Recommendations for the therapy of multifocal atrial tachycardia . . . . |
24 |
Recommendations for the therapy of macro-re-entrant atrial |
|
arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
25 |
Recommendations for the management of atrioventricular |
|
nodal re-entrant tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
30 |
Recommendations for the therapy of atrioventricular re-entrant |
|
tachycardia due to manifest or concealed accessory pathways . . . . . . . |
36 |
Recommendations for the acute therapy of pre-excited atrial |
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fibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
37 |
Recommendations for the management of patients with |
|
asymptomatic pre-excitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
39 |
Recommendations for the therapy of supraventricular tachycardias |
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in congenital heart disease in adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
42 |
Recommendations for the therapy of supraventricular tachycardia |
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in pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
44 |
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4 |
ESC Guidelines |
Recommendations for the therapy of supraventricular tachycardia |
|
in patients with suspected or established heart failure due to |
|
tachycardiomyopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
45 |
Recommendations for the acute management of narrow QRS |
|
tachycardia in the absence of an established diagnosis . . . . . . . . . . . . . . . |
48 |
List of tables |
|
Table 1 Classes of recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
6 |
Table 2 Levels of evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
6 |
Table 3 Changes in drug recommendations since 2003 . . . . . . . . . . . . . . |
7 |
Table 4 New recommendations in 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
8 |
Table 5 Conventional classification of supraventricular |
|
tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
9 |
Table 6 Differential diagnosis of narrow and wide QRS |
|
tachycardias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
9 |
Table 7 Initial evaluation of the patient with supraventricular |
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tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
10 |
Table 8 Possible responses of narrow QRS tachycardia to vagal |
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manoeuvres and adenosine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
13 |
Table 9 Summary of key electrocardiographic criteria that suggest |
|
ventricular tachycardia rather than supraventricular tachycardia |
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in wide complex tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
14 |
Table 10 Causes of physiological sinus tachycardia . . . . . . . . . . . . . . . . . . |
19 |
Table 11 Average success and complications rates of catheter |
|
ablation for supraventricular tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
23 |
Table 12 Classification of atrioventricular nodal re-entrant |
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tachycardia types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
30 |
Table 13 Recommendations for sports participation in athletes |
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with ventricular pre-excitation and supraventricular arrhythmias . . . . |
46 |
Table 14 European Working Group 2013 report on driving |
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and cardiovascular disease: driving in arrhythmias and conduction |
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disorders: supraventricular tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
47 |
List of figures |
|
Figure 1 Differential diagnosis of narrow QRS tachycardia. . . . . . . . . . . . |
12 |
Figure 2 Responses of narrow complex tachycardias to |
|
adenosine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 |
|
Figure 3 Examples of positive and negative chest lead |
|
concordance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 |
|
Figure 4 Acute therapy of narrow QRS tachycardia in the absence |
|
of an established diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
17 |
Figure 5 Acute therapy of wide complex tachycardia in the |
|
absence of an established diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
18 |
Figure 6 Therapy of sinus tachycardias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
20 |
Figure 7 Focal atrial tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
22 |
Figure 8 Acute therapy of focal atrial tachycardia . . . . . . . . . . . . . . . . . . . . |
23 |
Figure 9 Chronic therapy of focal atrial tachycardia . . . . . . . . . . . . . . . . . . |
23 |
Figure 10 Counter-clockwise and clockwise atrial flutter |
|
with 2:1 atrioventricular conduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
24 |
Figure 11 Acute therapy of stable atrial flutter or macro-re-entrant |
|
atrial tachycardia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
26 |
Figure 12 Chronic therapy of atrial flutter/macro-re-entrant |
|
atrial tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
28 |
Figure 13 Atrioventricular nodal re-entrant tachycardia . . . . . . . . . . . . . |
29 |
Figure 14 Acute therapy of atrioventricular nodal re-entrant |
|
tachycardia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
31 |
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Figure 15 Chronic therapy of atrioventricular nodal |
|
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re-entrant tachycardia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
32 |
|
Figure 16 The St George’s algorithm for localization of |
|
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accessory pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
33 |
|
Figure 17 Localization of accessory pathways in the presence |
|
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of maximum (spontaneous or evoked) pre-excitation . . . . . . . . . . . . . . . |
34 |
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Figure 18 Atrioventricular re-entrant tachycardia . . . . . . . . . . . . . . . . . . . |
35 |
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Figure 19 Acute therapy of atrioventricular re-entrant |
|
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tachycardia. . . . |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
37 |
Figure 20 Acute therapy of pre-excited atrial fibrillation. . . . . . . . . . . . . . |
38 |
|
Figure 21 Chronic therapy of atrioventricular re-entrant |
|
|
tachycardia. . . . |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
38 |
Figure 22 Risk stratification and therapy of patients with |
|
|
asymptomatic pre-excitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
40 |
|
Abbreviations and acronyms |
|
|
þ/- |
QRS complex equiphasic |
|
þve |
QRS complex-positive |
|
ve |
QRS complex-negative |
|
ACHD |
Adult congenital heart disease |
|
AEPC |
Association for European Paediatric and Congenital |
|
|
Cardiology |
|
AF |
Atrial fibrillation |
|
AH |
Atrial His |
|
AMP |
Adenosine monophosphate |
|
AP |
Accessory pathway |
|
AT |
Atrial tachycardia |
|
AV |
Atrioventricular |
|
AVN |
Atrioventricular node |
|
AVNRT |
Atrioventricular nodal re-entrant tachycardia |
|
AVRT |
Atrioventricular re-entrant tachycardia |
|
BBB |
Bundle branch block |
|
b.p.m. |
Beats per minute |
|
CHA2DS2Cardiac failure, Hypertension, Age >75 (Doubled), |
||
VASc |
Diabetes, Stroke (Doubled) Vascular disease, |
|
|
Age 65 74 and Sex category (Female) |
|
CL |
Cycle length |
|
CMR |
Cardiac magnetic resonance |
|
CT |
Computed tomography |
|
CTI |
Cavotricuspid isthmus |
|
CV |
Conduction velocity |
|
CYP |
Cytochrome P450 |
|
DAD |
Delayed after-depolarization |
|
DC |
Direct current |
|
DCS |
Distal coronary sinus |
|
EA |
Enhanced automaticity |
|
EAD |
Early after-depolarization |
|
ECG |
Electrocardiogram/electrocardiographic |
|
EPS |
Electrophysiology study |
|
ERP |
Effective refractory period |
|
ESC |
European Society of Cardiology |
|
HA |
His atrial interval |
|
HCN |
Hyperpolarization-activated cyclic nucleotide-gated |
|
|
potassium channel |
|
HF |
Heart failure |
|
2019 September 13 on guest by 1093/eurheartj/ehz467/5556821.abstract/doi/10-article-com/eurheartj/advance.oup.https://academic from Downloaded
ESC Guidelines |
5 |
HFrEF |
Heart failure with reduced ejection fraction |
HPS |
His Purkinje system |
HV |
His ventrcular interval |
ICaL |
L-type Ca2þ current |
ICD |
Implantable cardioverter defibrillator |
IST |
Inappropriate sinus tachycardia |
i.v. |
Intravenous |
JET |
Junctional ectopic tachycardia |
LA |
Left atrial/atrium |
LAL |
Left anterolateral |
LBBB |
Left bundle branch block |
LL |
Left lateral |
LP |
Left posterior |
LPL |
Left posterolateral |
LPS |
Left posteroseptal |
LV |
Left ventricle/ventricular |
MI |
Myocardial infarction |
MRAT |
Macro-re-entrant atrial tachycardia |
MS |
Mid-septal |
NT-proBNP |
N-terminal pro-B-type natriuretic peptide |
PJRT |
Permanent junctional reciprocating tachycardia |
p.o. |
Per os (by mouth) |
POTS |
Postural orthostatic tachycardia syndrome |
PPM |
Permanent pacemaker |
PRKAG2 |
Protein kinase AMP-activated non-catalytic subunit |
|
gamma 2 |
PV |
Pulmonary vein |
RA |
Right atrial/anterior |
RAS |
Right anteroseptal |
RBBB |
Right bundle branch block |
RCT |
Randomized clinical trial |
RL |
Right lateral |
RP |
Right posterior |
RPS |
Right posteroseptal |
RyR |
Sarcoplasmic reticulum Ca2þ channel |
SPERRI |
Shortest pre-excited RR interval during atrial |
|
fibrillation |
SR |
Sarcoplasmic reticulum |
SVT |
Supraventricular tachycardia |
TA |
Triggered activity |
TCM |
Tachycardiomyopathy |
TDI |
Tissue Doppler imaging |
VA |
Ventriculoatrial |
VT |
Ventricular tachycardia |
WL |
Wavelength |
WPW |
Wolff-Parkinson-White |
1 Preamble
Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the
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responsible health professional(s) in consultation with the patient and caregiver as appropriate.
A great number of guidelines have been issued in recent years by the European Society of Cardiology (ESC), as well as by other societies and organisations. Because of their impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/Guidelines-&- Education/Clinical-Practice-Guidelines/Guidelines-development/Writ ing-ESC-Guidelines). The ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated.
The ESC carries out a number of registries which are essential to assess, diagnostic/therapeutic processes, use of resources and adherence to Guidelines. These registries aim at providing a better understanding of medical practice in Europe and around the world, based on data collected during routine clinical practice.
The guidelines are developed together with derivative educational material addressing the cultural and professional needs for cardiologists and allied professionals. Collecting high-quality observational data, at appropriate time interval following the release of ESC Guidelines, will help evaluate the level of implementation of the Guidelines, checking in priority the key end points defined with the ESC Guidelines and Education Committees and Task Force members in charge.
The Members of this Task Force were selected by the ESC, including representation from its relevant ESC sub-specialty groups, in order to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for management of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk benefit ratio. The level of evidence and the strength of the recommendation of particular management options were weighed and graded according to predefined ESC scales, as outlined in tables 1 and 2 below.
The experts of the writing and reviewing panels provided declaration of interest forms for all relationships that might be perceived as real or potential sources of conflicts of interest. These forms were compiled into one file and can be found on the ESC website (http:// www.escardio.org/guidelines). Any changes in declarations of interest that arise during the writing period were notified to the ESC and updated. The Task Force received its entire financial support from the ESC without any involvement from the healthcare industry.
The ESC CPG supervises and coordinates the preparation of new Guidelines. The Committee is also responsible for the endorsement process of these Guidelines. The ESC Guidelines undergo extensive review by the CPG and external experts. After appropriate revisions the Guidelines are approved by all the experts involved in the Task Force. The finalized document is approved by the CPG for publication in the European Heart Journal. The Guidelines were developed after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating.
The task of developing ESC Guidelines also includes the creation of educational tools and implementation programmes for the recommendations including condensed pocket guideline versions, summary
2019 September 13 on guest by 1093/eurheartj/ehz467/5556821.abstract/doi/10-article-com/eurheartj/advance.oup.https://academic from Downloaded