Acute Management of Narrow Complex Tachycardia

• Vagal manuever, Adenosine, CV
• BB, CCB

• NO AMIODARONE OR DIGOXIN

2019 ESC Guidelines for SVT

Catheter Ablation over Drugs in most types of SVT.

Approximately 45% of the patients with infrequent and shorter duration of SVT episodes (ie.< 5 mins) stayed asymptomatic over the next decade.

D'Este et al. Int J Cardiol 2007.

For
INAPPROPRIATE SINUS TACHYCARDIA,
consider Ivabradine and/or Beta-blockers and titrate to perfection.

Asymptomatic WPW
• 1/5 will develop arrrhythmias related to accessory pathway.
• Risk of VF occurred in 2 in 1000 person-years.
• Consider EP study in pilots, professional drivers, or competitive athletes (I).
• May consider EP study in other asymptomatic WPW (IIa).

Antegrade ERP of Pathway = 300ms = not high-risk

Electrical Dyssynchrony esp. from right sided accessory pathways in septum or free wall may cause LV dysfunction.
Catheter ablation should therefore be considered (IIa).

For prevention of SVT in pregnant women,

BB except atenolol or verapamil for prevention of SVT w/o pre-excitation (IIa).

Flecainide or Propafenone for prevention of SVT w/ pre-excitation w/o structural heart disease (IIa).

NO AMIODARONE
in preexcited AF.

BB, CCB, and digoxin are not recommended either.

VERAPAMIL is not recommended in WCT of unknown etiology.

Flecainide/Propafenone are not recommended for acute treatment of atrial flutter.