ESC Congress in Review - Main Edition 2019 - 11

ESC Congress 2019 In Review

During the first trimester of pregnancy, it is recommended that
all antiarrhythmic drugs are avoided, if possible.

In pregnant women, beta-1 selective blockers (except atenolol)
or verapamil, in order of preference, should be considered for
prevention of SVT in patients without WPW syndrome.

IIa

In pregnant women, flecainide or propafenone should be considered
for prevention of SVT in patients with WPW syndrome and without
ischaemic or structural heart disease.

IIa

Haemodynamically stable patients

Class of recommendation

AF, atrial fibrillation; AP, accessory pathway; AT, atrial tachycardia; AV, atrioventricular; EPS, electrophysiology study; ERP, effective refractory period; HF, heart
failure; i.v., intravenous; LV, left ventricular; POTS, postural orthostatic tachycardia
syndrome; SPERRI, shortest pre-excited RR interval during AF; SVT, supraventricular tachycardia; TCM, tachycardiomyopathy; WPW, Wolff-Parkinson-White.
Reproduced from Brugada J et al. 2019 ESC Guidelines for the management
of patients with supraventricular tachycardia. Eur Heart J. 2019. Doi:10.1093/
eurheartj/ehz467. By permission of Oxford University Press on behalf of the
European Society of Cardiology.

Table 9. Key Messages from the 2019 Guidelines on Supraventricular
Tachycardia: 'What to Do' and 'What not to Do'
'What to do' messages

Classa

Levelb

Recommendations for acute management of narrow QRS
tachycardia in the absence of an estabished diagnosis

Synchronised DC cardioversion is recommended if drug
therapy fails to convert or control the tachycardia.

A 12 lead ECG during tachycardia is recommended.

Vagal manoeuvres, preferably in the supine position
with leg elevation, are recommended.

Recommendations for the management of patients with
asymptomatic pre-excitation
Performance of an EPS, with the use of isoprenaline, is
recommended to risk stratify individuals with asymptomatic pre-excitation who have high-risk occupations/hobbies and those who participate in competitive athletics.
Catheter ablation is recommended in asymptomatic
patients in whom electrophysiology testing with use
of isoprenaline identifies high-risk properties, such as
SPERRI ≤250 ms, AP ERP ≤250 ms, multiple APs, and an
inducible AP-mediated tachycardia.

A 12 lead ECG during tachycardia is recommended.

Vagal manoeuvres are recommended.

Catheter ablation is recommended in symptomatic
women with recurrent SVT who plan to become
pregnant.

Chronic therapy
During the first tremester of pregnancy, it is recommended that all antiarrhythmic drugs are avoided, if possible.

Catheter ablation is recommended for TCM due to SVT.

AV nodal ablation with subsequent pacing ('ablate
and pace'), either biventricular or His-bundle pacing,
is recommended if the tachycardia responsible for
the TCM cannot be ablated or controlled by drugs.

Verapamil is not recommended in wide QRS-complex
tachycardia of unknown aetiology.

Chronic therapy

Propafenone and flecainide are not recommended for
conversion to sinus rhythm.

Recommendations for the therapy of focal MRATs

Chronic therapy
Catheter ablation is recommended for symptomatic,
recurrent episodes of CTI-dependent flutter.

Catheter ablation is recommended in patients with
persistent atrial flutter or in the presence of depressed
LV systolic function due to TCM.

III

Recommendations for the therapy of MRATs
Acute therapy

Recommendations for the therapy of AVRT due to manifest or
concealed APs
Chronic therapy
Digoxin, beta-blockers, diltiazem, verapamil, and amiodarone are not recommended and are potentially harmful in
patients with pre-excited AF.

III

Recommendations for the acute therapy of pre-excited AF
Haemodynamiccally stable patients
Amiodarone (i.v.) is not recommended.

III

Recommendations for the therapy of SVTs in congenital heart
disease in adults

Recommendations for the management of focal AVNRT
Chronic therapy

Chronic therapy
I

Recommendations for the therapy of AVRT due to manifest or
concealed APs
Catheter ablation of AP(s) is recommended in patients
with symptomatic, recurrent AVRT.

Recommendations for the therapy SVT in pregnancy

Recommendations for the therapy of focal AT

Catheter ablation is recommended in symptomatic,
recurrent AVNRT.

Recommendations for the acute management of wide QRS
tachycardia in the absence of an established diagnoses

Haemodynamically stable patients

Anticoagulation as in AF is recommended for patients
with atrial flutter and concomitant AF.

'What not to do' messages

Recommendations for acute management of wide QRS
tachycardia in the absence of an estabished diagnosis

Catheter ablation is recommended for recurrent focal
AT, especially if incessant or causing TCM.

Recommendations for the therapy of SVT in patients with
suspected or established HF due to TCM

Haemodynamically stable patients

Adenosine (6-8 mg i.v. bolus) is recommended if vagal
manoeuvres fail.

Recommendations for the acute therapy of pre-excited AF

Sotalol is not recommended as a first-line antiarrhythmic
drug as it is related to an increased risk of pro-arrhythmias and mortality.

III

Flecainide and propafenone are not recommended as
first-line antiarrhythmic drugs in patients with ventricular dysfunction and severe fibrosis.

III

Official Peer-Reviewed Highlights From ESC Congress 2019

https://doi.org/10.1093/eurheartj/ehz467 https://doi.org/10.1093/eurheartj/ehz467

ESC Congress in Review - Main Edition 2019

Table of Contents for the Digital Edition of ESC Congress in Review - Main Edition 2019