ESC 2019 — New supraventricular tachycardia guidelines set up a catheter ablation revolution


  • Emily Willingham, PhD
  • Conference Reports
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Takeaway

Why this matters

  • Although drug therapies have changed little since the previous guidelines, sufficient data have accumulated for this update to include data on risks vs benefits and the safest use of these therapies, said Josep Brugada, a guidelines task force chair, in a statement. 
  • Some new antiarrhythmics have entered the market for acute use, but the emphasis in this update is on improvements in safety and efficiency of catheter ablation for long-term benefit.
  • Demosthenes Katritsis, also a guidelines task force chair, said, "we can now offer this treatment modality to most of our patients with SVT.”

Key highlights

  • New additions to the guidelines are tabulated here. 
    • They include a class I recommendation for ibutilide for atrial flutter conversion and a class I recommendation to avoid all antiarrhythmics in the first trimester of pregnancy (if possible).
  • Changes to previous recommendations are summarized here. 
    • Most involve shifts in recommendation grades for drug therapies.
  • Clinicians can get a quick look at what to do and what not to do here. 
  • Among the key messages is to offer catheter ablation as an initial choice in all re-entrant and most focal arrhythmias, along with a thorough discussion of risks and benefits.

Additional note