This paper is an executive summary of the full European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, published in Europace. It summarises developments in the field and provides recommendations for patient management, with particular emphasis on new advances since the previous European Society of Cardiology guidelines. The EHRA consensus document is available to read in full at http://europace.oxfordjournals.org
Endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE)
This is an executive summary of the full consensus document on the management of supraventricular tachycardia (SVT) patients published in Europace. The consensus document was prepared by a Task Force from the European Heart Rhythm Association (EHRA) with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). It summarises current developments in the field and provides recommendations for the management of patients with SVT based on the principles of evidence-based medicine, with focus on new advances since the last ESC guidelines.1 It does not cover atrial fibrillation, which is the subject of a separate clinical guideline.
The process for evidence review has been described in the full document. Consensus statements are evidence-based, and derived primarily from published data. Current systems of ranking level of evidence are becoming complicated in a way that their practical utility might be compromised. We have, therefore, opted for an easier and, perhaps, more user-friendly system of ranking that should allow physicians to easily assess current status of evidence and consequent guidance (see Table 1). EHRA grading of consensus statements does not have separate definitions of Level of Evidence.
Diagnosis and Management of SVT
The term supraventricular tachycardia literally indicates tachycardias (atrial and/or ventricular rates >100 bpm at rest), the mechanism of which involves tissue from the His bundle or above (see Table 2). Traditionally, however, SVT has been used to describe all kinds of tachycardias apart from ventricular tachycardias and atrial fibrillation (AF), the mechanisms of which are illustrated in Figure 1. The term narrow-QRS tachycardia indicates those with a QRS duration ≤ 120 ms. A wide-QRS tachycardia refers to one with a QRS duration >120 ms (see Table 3). In clinical practice, SVT may present as narrow- or wide-QRS tachycardias, and most of them usually, although not invariably, manifest as regular rhythms.
Recommendations for the differential diagnosis of various forms of supraventricular tachycardias, as well as supporting references, are included in Figures 2–6. Recommendations for acute treatment preferences are given. Long-term treatment with antiarrhythmic drugs and/or catheter ablation are also presented and described for each type of SVT, with detailed recommendations given in Figure 7 and Tables 4–15. As compared with the previous SVT guideline from 2003, this consensus document contains several new recommendations based on new trials and meta-analyses, such as the management of patients with asymptomatic Wolff-Parkinson-White syndrome, and the cautious use of certain antiarrhythmic drugs in adult congenital heart diseases. Some discrepancies with the corresponding American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines of 20152 may be related to new evidence that has emerged as well as differences in interpretation of studies and experts’ opinion.
- Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines. Circulation 2003;108:1871–909.
Crossref | PubMed - Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/ HRS guideline for the management of adult patients with supraventricular tachycardia: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2016;67:e27–e115.
Crossref | PubMed - Roth A, Elkayam I, Shapira I, et al. Effectiveness of prehospital synchronous direct-current cardioversion for supraventricular tachyarrhythmias causing unstable hemodynamic states. Am J Cardiol. 2003;91:489–91.
Crossref | PubMed - Wittwer MR, Rajendran S, Kealley J, Arstall MA. A South Australian registry of biphasic cardioversions of atrial arrhythmias: Efficacy and predictors of success. Heart Lung Circ. 2015;24:342–7.
Crossref | PubMed - Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): A randomised controlled trial. Lancet 2015;386:1747–53.
Crossref | PubMed - Lim SH, Anantharaman V, Teo WS, et al. Comparison of treatment of supraventricular tachycardia by valsalva maneuver and carotid sinus massage. Ann Emerg Med 1998;31:30–5.
Crossref | PubMed - Smith GD, Fry MM, Taylor D, et al. Effectiveness of the valsalva manoeuvre for reversion of supraventricular tachycardia. Cochrane Database Syst Rev 2015;2:CD009502.
Crossref | PubMed - Wen ZC, Chen SA, Tai CT, et al. Electrophysiological mechanisms and determinants of vagal maneuvers for termination of paroxysmal supraventricular tachycardia. Circulation 1998;98:2716–23.
Crossref | PubMed - Brady WJ, Jr., DeBehnke DJ, Wickman LL, Lindbeck G. Treatment of out-of-hospital supraventricular tachycardia: Adenosine vs verapamil. Acad Emerg Med 1996;3:574–85.
Crossref | PubMed - Delaney B, Loy J, Kelly AM. The relative efficacy of adenosine versus verapamil for the treatment of stable paroxysmal supraventricular tachycardia in adults: A meta-analysis. Eur J Emerg Med 2011;18:148–52.
Crossref | PubMed - DiMarco JP, Miles W, Akhtar M, et al. Adenosine for paroxysmal supraventricular tachycardia: Dose ranging and comparison with verapamil. Assessment in placebo-controlled, multicenter trials. The adenosine for PSVT study group. Ann Intern Med 1990;113:104–10.
Crossref | PubMed - Glatter KA, Cheng J, Dorostkar P, et al. Electrophysiologic effects of adenosine in patients with supraventricular tachycardia. Circulation 1999;99:1034–40.
Crossref | PubMed - Gupta A, Naik A, Vora A, Lokhandwala Y. Comparison of efficacy of intravenous diltiazem and esmolol in terminating supraventricular tachycardia. J Assoc Physicians India 1999;47:969–72.
PubMed - Hood MA, Smith WM. Adenosine versus verapamil in the treatment of supraventricular tachycardia: A randomized double-crossover trial. Am Heart J 1992;123:1543–9.
Crossref | PubMed - Lim SH, Anantharaman V, Teo WS, Chan YH. Slow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia. Resuscitation 2009;80:523–8.
Crossref | PubMed - Amsterdam EA, Kulcyski J, Ridgeway MG. Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias. J Clin Pharmacol 1991;31:714–8.
Crossref | PubMed - Das G, Tschida V, Gray R, et al. Efficacy of esmolol in the treatment and transfer of patients with supraventricular tachyarrhythmias to alternate oral antiarrhythmic agents. J Clin Pharmacol 1988;28:746–50.
Crossref | PubMed - Cappato R, Castelvecchio S, Ricci C, et al. Clinical efficacy of ivabradine in patients with inappropriate sinus tachycardia: A prospective, randomized, placebo-controlled, double-blind, crossover evaluation. J Am Coll Cardiol 2012;60:1323–9.
Crossref | PubMed - Ptaszynski P, Kaczmarek K, Ruta J, et al. Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy. Europace 2013;15:116–21.
Crossref | PubMed - Shen WK. How to manage patients with inappropriate sinus tachycardia. Heart Rhythm 2005;2:1015–9.
Crossref | PubMed - Gianni C, Di Biase L, Mohanty S, et al. Catheter ablation of inappropriate sinus tachycardia. J Interv Card Electrophysiol 2016;46:63-9.
Crossref | PubMed - Jacobson JT, Kraus A, Lee R, Goldberger JJ. Epicardial/ endocardial sinus node ablation after failed endocardial ablation for the treatment of inappropriate sinus tachycardia. J Cardiovasc Electrophysiol 2014;25:236–41.
Crossref | PubMed - Leonelli FM, Pisano E, Requarth JA, et al. Frequency of superior vena cava syndrome following radiofrequency modification of the sinus node and its management. Am J Cardiol 2000;85:771–4, A779.
Crossref | PubMed - Sanders WE Jr, Sorrentino RA, Greenfield RA, et al. Catheter ablation of sinoatrial node reentrant tachycardia. J Am Coll Cardiol 1994;23:926–34.
Crossref | PubMed - Gomes JA, Hariman RJ, Kang PS, Chowdry IH. Sustained symptomatic sinus node reentrant tachycardia: Incidence, clinical significance, electrophysiologic observations and the effects of antiarrhythmic agents. J Am Coll Cardiol 1985;5:45–57.
Crossref | PubMed - Markowitz SM, Stein KM, Mittal S, et al. Differential effects of adenosine on focal and macroreentrant atrial tachycardia. J Cardiovasc Electrophysiol 1999;10:489–502.
Crossref | PubMed - Kall JG, Kopp D, Olshansky B, et al. Adenosine-sensitive atrial tachycardia. Pacing Clin Electrophysiol 1995;18:300–6.
Crossref | PubMed - Arsura E, Lefkin AS, Scher DL, et al. A randomized, doubleblind, placebo-controlled study of verapamil and metoprolol in treatment of multifocal atrial tachycardia. Am J Med 1988;85:519–24.
Crossref | PubMed - Hohnloser SH, Zabel M. Short- and long-term efficacy and safety of flecainide acetate for supraventricular arrhythmias. Am J Cardiol 1992;70:3A-9A; discussion 9A–10A.
Crossref | PubMed - Kunze KP, Kuck KH, Schluter M, Bleifeld W. Effect of encainide and flecainide on chronic ectopic atrial tachycardia. J Am Coll Cardiol 1986;7:1121–6.
Crossref | PubMed - Vietti-Ramus G, Veglio F, Marchisio U, et al. Efficacy and safety of short intravenous amiodarone in supraventricular tachyarrhythmias. Int J Cardiol 1992;35:77–85.
Crossref | PubMed - Coumel P, Fidelle J. Amiodarone in the treatment of cardiac arrhythmias in children: One hundred thirty-five cases. Am Heart J 1980;100:1063–9.
Crossref | PubMed - Eidher U, Freihoff F, Kaltenbrunner W, Steinbach K. Efficacy and safety of ibutilide for the conversion of monomorphic atrial tachycardia. Pacing Clin Electrophysiol 2006;29:358–62.
Crossref | PubMed - Anguera I, Brugada J, Roba M, et al. Outcomes after radiofrequency catheter ablation of atrial tachycardia. Am J Cardiol 2001;87:886–90.
Crossref | PubMed - Zhang XD, Gu J, Jiang WF, et al. Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: A randomized clinical trial. Eur Heart J 2014;35:1327–34.
Crossref | PubMed - Mehta AV, Sanchez GR, Sacks EJ, et al. Ectopic automatic atrial tachycardia in children: Clinical characteristics, management and follow-up. J Am Coll Cardiol 1988;11:379–85.
Crossref | PubMed - Yamabe H, Okumura K, Koyama J, et al. Demonstration of anatomic reentrant circuit in verapamil-sensitive atrial tachycardia originating from the atrioventricular annulus other than the vicinity of the atrioventricular node. Am J Cardiol 2014;113:1822–8.
Crossref | PubMed - Heusch A, Kramer HH, Krogmann ON, et al. Clinical experience with propafenone for cardiac arrhythmias in the young. Eur Heart J 1994;15:1050–6.
PubMed - Hazard PB, Burnett CR. Treatment of multifocal atrial tachycardia with metoprolol. Crit Care Med 1987;15:20–5.
Crossref | PubMed - Van Gelder IC, Crijns HJ, Van Gilst WH, et al. Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation and flutter. Am J Cardiol 1991;68:41–6.
Crossref | PubMed - Gallagher MM, Guo XH, Poloniecki JD, et al. Initial energy setting, outcome and efficiency in direct current cardioversion of atrial fibrillation and flutter. J Am Coll Cardiol 2001;38:1498– 504.
Crossref | PubMed - Grimm RA, Stewart WJ, Arheart K, et al. Left atrial appendage “stunning” after electrical cardioversion of atrial flutter: An attenuated response compared with atrial fibrillation as the mechanism for lower susceptibility to thromboembolic events. J Am Coll Cardiol 1997;29:592–9.
Crossref | PubMed - Irani WN, Grayburn PA, Afridi I. Prevalence of thrombus, spontaneous echo contrast, and atrial stunning in patients undergoing cardioversion of atrial flutter. A prospective study using transesophageal echocardiography. Circulation 1997;95:962–6.
Crossref | PubMed - Ellenbogen KA, Dias VC, Plumb VJ, et al. A placebo-controlled trial of continuous intravenous diltiazem infusion for 24-hour heart rate control during atrial fibrillation and atrial flutter: A multicenter study. J Am Coll Cardiol 1991;18:891–7.
Crossref | PubMed - Platia EV, Michelson EL, Porterfield JK, Das G. Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter. Am J Cardiol 1989;63:925–9.
Crossref | PubMed - Salerno DM, Dias VC, Kleiger RE, et al. Efficacy and safety of intravenous diltiazem for treatment of atrial fibrillation and atrial flutter. The diltiazem-atrial fibrillation/flutter study group. Am J Cardiol 1989;63:1046–51.
Crossref | PubMed - Crijns HJ, Van Gelder IC, Kingma JH, et al. Atrial flutter can be terminated by a class III antiarrhythmic drug but not by a class IC drug. Eur Heart J 1994;15:1403–8.
PubMed - Falk RH, Pollak A, Singh SN, Friedrich T. Intravenous dofetilide, a class III antiarrhythmic agent, for the termination of sustained atrial fibrillation or flutter. Intravenous dofetilide investigators. J Am Coll Cardiol 1997;29:385–90.
Crossref | PubMed - Stambler BS, Wood MA, Ellenbogen KA. Antiarrhythmic actions of intravenous ibutilide compared with procainamide during human atrial flutter and fibrillation: Electrophysiological determinants of enhanced conversion efficacy. Circulation 1997;96:4298–306.
Crossref | PubMed - Volgman AS, Carberry PA, Stambler B, et al. Conversion efficacy and safety of intravenous ibutilide compared with intravenous procainamide in patients with atrial flutter or fibrillation. J Am Coll Cardiol 1998;31:1414–9.
Crossref | PubMed - Vos MA, Golitsyn SR, Stangl K, et al. Superiority of ibutilide (a new class III agent) over dl-sotalol in converting atrial flutter and atrial fibrillation. The ibutilide/sotalol comparator study group. Heart 1998;79:568–75.
Crossref | PubMed - Bianconi L, Castro A, Dinelli M, et al. Comparison of intravenously administered dofetilide versus amiodarone in the acute termination of atrial fibrillation and flutter. A multicentre, randomized, double-blind, placebo-controlled study. Eur Heart J 2000;21:1265–73.
Crossref | PubMed - Kafkas NV, Patsilinakos SP, Mertzanos GA, et al. Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter. Int J Cardiol 2007;118:321–5.
Crossref | PubMed - Rhodes LA, Walsh EP, Saul JP. Conversion of atrial flutter in pediatric patients by transesophageal atrial pacing: A safe, effective, minimally invasive procedure. Am Heart J 1995;130:323–7.
Crossref | PubMed - Brockmeier K, Ulmer HE, Hessling G. Termination of atrial reentrant tachycardias by using transesophageal atrial pacing. J Electrocardiol 2002;35: Suppl:159–63.
Crossref | PubMed - Stephenson EA, Casavant D, Tuzi J, et al. Efficacy of atrial antitachycardia pacing using the medtronic AT500 pacemaker in patients with congenital heart disease. Am J Cardiol 2003;92:871–6.
Crossref | PubMed - Doni F, Della Bella P, Kheir A, et al. Atrial flutter termination by overdrive transesophageal pacing and the facilitating effect of oral propafenone. Am J Cardiol 1995;76:1243–6.
Crossref | PubMed - Singh S, Zoble RG, Yellen L, et al. Efficacy and safety of oral dofetilide in converting to and maintaining sinus rhythm in patients with chronic atrial fibrillation or atrial flutter: The symptomatic atrial fibrillation investigative research on dofetilide (SAFIRE-D) study. Circulation 2000;102:2385–90.
Crossref | PubMed - Crozier IG, Ikram H, Kenealy M, Levy L. Flecainide acetate for conversion of acute supraventricular tachycardia to sinus rhythm. Am J Cardiol 1987;59:607–9.
Crossref | PubMed - Murdock CJ, Kyles AE, Yeung-Lai-Wah JA, et al. Atrial flutter in patients treated for atrial fibrillation with propafenone. Am J Cardiol 1990;66:755–7.
Crossref | PubMed - Crijns HJ, Van Gelder IC, Tieleman RG, et al. Long-term outcome of electrical cardioversion in patients with chronic atrial flutter. Heart 1997;77:56–61.
Crossref | PubMed - Da Costa A, Thevenin J, Roche F, et al. Results from the Loire-Ardeche-Drome-Isere-Puy-de-Dome (LADIP) trial on atrial flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter. Circulation 2006;114:1676–81.
Crossref | PubMed - Natale A, Newby KH, Pisano E, et al. Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. J Am Coll Cardiol 2000;35:1898–904.
Crossref | PubMed - Luchsinger JA, Steinberg JS. Resolution of cardiomyopathy after ablation of atrial flutter. J Am Coll Cardiol 1998;32:205–10.
Crossref | PubMed - Pizzale S, Lemery R, Green MS, et al. Frequency and predictors of tachycardia-induced cardiomyopathy in patients with persistent atrial flutter. Can J Cardiol 2009;25:469–72.
Crossref | PubMed - Chae S, Oral H, Good E, et al. Atrial tachycardia after circumferential pulmonary vein ablation of atrial fibrillation: Mechanistic insights, results of catheter ablation, and risk factors for recurrence. J Am Coll Cardiol 2007;50:1781–87.
Crossref | PubMed - Daoud EG, Weiss R, Augostini R, et al. Proarrhythmia of circumferential left atrial lesions for management of atrial fibrillation. J Cardiovasc Electrophysiol 2006;17:157–65.
Crossref | PubMed - Marrouche NF, Natale A, Wazni OM, et al. Left septal atrial flutter: Electrophysiology, anatomy, and results of ablation. Circulation 2004;109:2440–7.
Crossref | PubMed - Lukac P, Pedersen AK, Mortensen PT, et al. Ablation of atrial tachycardia after surgery for congenital and acquired heart disease using an electroanatomic mapping system: Which circuits to expect in which substrate? Heart Rhythm 2005;2:64–72.
Crossref | PubMed - Bai R, Fahmy TS, Patel D, et al. Radiofrequency ablation of atypical atrial flutter after cardiac surgery or atrial fibrillation ablation: A randomized comparison of open-irrigation-tip and 8-mm-tip catheters. Heart Rhythm. 2007;4:1489–96.
Crossref | PubMed - Matsuo S, Wright M, Knecht S, et al. Peri-mitral atrial flutter in patients with atrial fibrillation ablation. Heart Rhythm 2010;7:2–8
Crossref | PubMed - Coffey JO, d’Avila A, Dukkipati S, et al. Catheter ablation of scar-related atypical atrial flutter. Europace. 2013;15:414–9.
Crossref | PubMed - Patel NJ, Deshmukh A, Pau D, et al. Contemporary utilization and safety outcomes of catheter ablation of atrial flutter in the United States: Analysis of 89,638 procedures. Heart Rhythm 2016;13:1317–25.
Crossref | PubMed - Pathak RK, Middeldorp ME, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: The ARREST-AF cohort study. J Am Coll Cardiol 2014;64:2222–31.
Crossref | PubMed - Mohanty S, Mohanty P, Di Biase L, et al. Long-term outcome of catheter ablation in atrial fibrillation patients with coexistent metabolic syndrome and obstructive sleep apnea: Impact of repeat procedures versus lifestyle changes. J Cardiovasc Electrophysiol 2014;25:930–38.
Crossref | PubMed - Pathak RK, Middeldorp ME, Meredith M, et al. Long-term effect of goal-directed weight management in an atrial fibrillation cohort: A long-term follow-up study (LEGACY). J Am Coll Cardiol 2015;65:2159–69.
Crossref | PubMed - Biblo LA, Yuan Z, Quan KJ, et al. Risk of stroke in patients with atrial flutter. Am J Cardiol 2001;87:346–9, A349.
Crossref | PubMed - Seidl K, Hauer B, Schwick NG, et al. Risk of thromboembolic events in patients with atrial flutter. Am J Cardiol. 1998;82:580–3.
Crossref | PubMed - Wood KA, Eisenberg SJ, Kalman JM, et al. Risk of thromboembolism in chronic atrial flutter. Am J Cardiol 1997;79:1043–7.
Crossref | PubMed - Smith G, Taylor DM, Morgans A, Cameron P. Prehospital synchronized electrical cardioversion of a poorly perfused svt patient by paramedics. Prehosp Disaster Med 2013;28:301–4.
Crossref | PubMed - Dougherty AH, Jackman WM, Naccarelli GV, et al. Acute conversion of paroxysmal supraventricular tachycardia with intravenous diltiazem. IV diltiazem study group. Am J Cardiol 1992;70:587–92.
Crossref | PubMed - Gambhir DS, Bhargava M, Nair M, et al. Comparison of electrophysiologic effects and efficacy of single-dose intravenous and long-term oral amiodarone therapy in patients with AV nodal reentrant tachycardia. Indian Heart J 1996;48:133–7.
PubMed - Yeh SJ, Lin FC, Chou YY, et al. Termination of paroxysmal supraventricular tachycardia with a single oral dose of diltiazem and propranolol. Circulation 1985;71:104–9.
Crossref | PubMed - Alboni P, Tomasi C, Menozzi C, et al. Efficacy and safety of out-of-hospital self-administered single-dose oral drug treatment in the management of infrequent, well-tolerated paroxysmal supraventricular tachycardia. J Am Coll Cardiol 2001;37:548–53.
Crossref | PubMed - Cheng CH, Sanders GD, Hlatky MA, et al. Cost-effectiveness of radiofrequency ablation for supraventricular tachycardia. Ann Intern Med 2000;133:864–76.
Crossref | PubMed - Farkowski MM, Pytkowski M, Maciag A, et al. Gender-related differences in outcomes and resource utilization in patients undergoing radiofrequency ablation of supraventricular tachycardia: Results from patients’ perspective on radiofrequency catheter ablation of AVRT and AVNRT study. Europace 2014;16:1821–7.
Crossref | PubMed - Katritsis D, Zografos T, Katritsis G, et al. Catheter ablation vs antiarrhythmic drug therapy in patients with symptomatic atrioventricular nodal reentrant tachycardia: A randomized, controlled trial. Europace 2016; First published online: 12 May 2016.
Crossref | PubMed - Spector P, Reynolds MR, Calkins H, et al. Meta-analysis of ablation of atrial flutter and supraventricular tachycardia. Am J Cardiol 2009;104:671–7.
Crossref | PubMed - Wood KA, Stewart AL, Drew BJ, et al. Patient perception of symptoms and quality of life following ablation in patients with supraventricular tachycardia. Heart Lung 2010;39:12–20.
Crossref | PubMed - Rinkenberger RL, Prystowsky EN, Heger JJ, et al. Effects of intravenous and chronic oral verapamil administration in patients with supraventricular tachyarrhythmias. Circulation 1980;62:996–1010.
Crossref | PubMed - Mauritson DR, Winniford MD, Walker WS, et al. Oral verapamil for paroxysmal supraventricular tachycardia: A long-term, double-blind randomized trial. Ann Intern Med 1982;96:409–12.
Crossref | PubMed - Winniford MD, Fulton KL, Hillis LD. Long-term therapy of paroxysmal supraventricular tachycardia: A randomized, double-blind comparison of digoxin, propranolol and verapamil. Am J Cardiol 1984;54:1138–9.
Crossref | PubMed - Sakurai M, Yasuda H, Kato N, et al. Acute and chronic effects of verapamil in patients with paroxysmal supraventricular tachycardia. Am Heart J 1983;105:619–28.
Crossref | PubMed - D’Este D, Zoppo F, Bertaglia E, et al. Long-term outcome of patients with atrioventricular node reentrant tachycardia. Int J Cardiol 2007;115:350–3.
Crossref | PubMed - Ruder MA, Davis JC, Eldar M, et al. Clinical and electrophysiologic characterization of automatic junctional tachycardia in adults. Circulation 1986;73:930–7.
Crossref | PubMed - Kumagai K, Yamato H, Yamanouchi Y, et al. Automatic junctional tachycardia in an adult. Clin Cardiol 1990;13:813–6.
Crossref | PubMed - Cook JR, Steinberg JS. An incessant form of junctional ectopic tachycardia in an adult responsive to a class 1C agent. Am Heart J 1991;122:1487–9.
Crossref | PubMed - Kuck KH, Kunze KP, Schluter M, Duckeck W. Encainide versus flecainide for chronic atrial and junctional ectopic tachycardia. Am J Cardiol 1988;62:37L–44L.
Crossref | PubMed - Paul T, Reimer A, Janousek J, Kallfelz HC. Efficacy and safety of propafenone in congenital junctional ectopic tachycardia. J Am Coll Cardiol 1992;20:911–4.
Crossref | PubMed - Hamdan M, Van Hare GF, Fisher W, et al. Selective catheter ablation of the tachycardia focus in patients with nonreentrant junctional tachycardia. Am J Cardiol 1996;78:1292–7.
Crossref | PubMed - Law IH, Von Bergen NH, Gingerich JC, et al. Transcatheter cryothermal ablation of junctional ectopic tachycardia in the normal heart. Heart Rhythm 2006;3:903–7.
Crossref | PubMed - Strickberger SA, Man KC, Daoud EG, et al. Adenosine-induced atrial arrhythmia: A prospective analysis. Ann Intern Med 1997;127:417–22.
Crossref | PubMed - Glatter KA, Dorostkar PC, Yang Y, et al. Electrophysiological effects of ibutilide in patients with accessory pathways. Circulation 2001;104:1933–9.
Crossref | PubMed - Ludmer PL, McGowan NE, Antman EM, Friedman PL. Efficacy of propafenone in wolff-parkinson-white syndrome: Electrophysiologic findings and long-term follow-up. J Am Coll Cardiol 1987;9:1357–63.
Crossref | PubMed - Sellers TD Jr, Campbell RW, Bashore TM, Gallagher JJ. Effects of procainamide and quinidine sulfate in the Wolff-Parkinson- White syndrome. Circulation 1977;55:15–22.
Crossref | PubMed - Hamer A, Peter T, Platt M, Mandel WJ. Effects of verapamil on supraventricular tachycardia in patients with overt and concealed Wolff-Parkinson-White syndrome. Am Heart J 1981;101:600–12.
Crossref | PubMed - Huycke EC, Sung RJ, Dias VC, et al. Intravenous diltiazem for termination of reentrant supraventricular tachycardia: A placebo-controlled, randomized, double-blind, multicenter study. J Am Coll Cardiol 1989;13:538–44.
Crossref | PubMed - Boriani G, Biffi M, Frabetti L, et al. Ventricular fibrillation after intravenous amiodarone in Wolff-Parkinson-White syndrome with atrial fibrillation. Am Heart J 1996;131:1214–6.
Crossref | PubMed - Morady F, DiCarlo LA Jr, Baerman JM, De Buitleir M. Effect of propranolol on ventricular rate during atrial fibrillation in the Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 1987;10:492–6.
Crossref | PubMed - Schützenberger W, Leisch F, Gmeiner R. Enhanced accessory pathway conduction following intravenous amiodarone in atrial fibrillation. A case report. Int J Cardiol 1987;16:93–5.
Crossref | PubMed - Sellers TD Jr, Bashore TM, JJ. G. Digitalis in the pre-excitation syndrome. Analysis during atrial fibrillation. Circulation 1977;56:260–7.
Crossref | PubMed - Sheinman BD, Evans T. Acceleration of ventricular rate by fibrillation associated with the Wolff-Parkinson-White syndrome. Br Med J (Clin Res Ed) 1982;285:999–1000.
Crossref | PubMed - Tijunelis MA, Herbert ME. Myth: Intravenous amiodarone is safe in patients with atrial fibrillation and Wolff-Parkinson- White syndrome in the emergency department. CJEM 2005;7:262–5.
Crossref | PubMed - Calkins H, Yong P, Miller JM, et al. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: Final results of a prospective, multicenter clinical trial. The ATAKR multicenter investigators group. Circulation 1999;99:262–70.
Crossref | PubMed - Jackman WM, Wang XZ, Friday KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson- White syndrome) by radiofrequency current. N Engl J Med 1991;324:1605–11.
Crossref | PubMed - Pappone C, Vicedomini G, Manguso F, et al. Wolff-Parkinson- White syndrome in the era of catheter ablation: Insights from a registry study of 2169 patients. Circulation 2014;130:811–9.
Crossref | PubMed - Chimienti M, Cullen MT Jr, Casadei G. Safety of flecainide versus propafenone for the long-term management of symptomatic paroxysmal supraventricular tachyarrhythmias. Report from the flecainide and propafenone Italian study (FAPIS) group. Eur Heart J 1995;16:1943–51.
PubMed - Hopson JR, Buxton AE, Rinkenberger RL, et al. Safety and utility of flecainide acetate in the routine care of patients with supraventricular tachyarrhythmias: Results of a multicenter trial. The flecainide supraventricular tachycardia study group. Am J Cardiol 1996;77:72A–82A.
Crossref | PubMed - UK Propafenone PSVT Study Group. A randomized, placebocontrolled trial of propafenone in the prophylaxis of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation. Circulation 1995;92:2550–7.
PubMed - Myerburg RJ, Kessler KM, Cox MM, et al. Reversal of proarrhythmic effects of flecainide acetate and encainide hydrochloride by propranolol. Circulation 1989;80:1571–9.
Crossref | PubMed - Breithardt G, Borggrefe M, Wiebringhaus E, Seipel L. Effect of propafenone in the wolff-parkinson-white syndrome: Electrophysiologic findings and long-term follow-up. Am J Cardiol 1984;54:29D–39D.
Crossref | PubMed - Vassiliadis I, Papoutsakis P, Kallikazaros I, Stefanadis C. Propafenone in the prevention of non-ventricular arrhythmias associated with the Wolff-Parkinson-White syndrome. Int J Cardiol 1990;27:63–70.
Crossref | PubMed - Feld GK, Nademanee K, Weiss J, et al. Electrophysiologic basis for the suppression by amiodarone of orthodromic supraventricular tachycardias complicating pre-excitation syndromes. J Am Coll Cardiol 1984;3:1298–307.
Crossref | PubMed - Feld GK, Nademanee K, Stevenson W, et al. Clinical and electrophysiologic effects of amiodarone in patients with atrial fibrillation complicating the Wolff-Parkinson-White syndrome. Am Heart J 1988;115:102–7.
Crossref | PubMed - Pappone C, Santinelli V. Should catheter ablation be performed in asymptomatic patients with Wolff-Parkinson- White syndrome? Catheter ablation should be performed in asymptomatic patients with Wolff-Parkinson-White syndrome. Circulation 2005;112:2207–15; discussion 2216.
PubMed - Pappone C, Santinelli V, Rosanio S, et al. Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff- Parkinson-White pattern: Results from a large prospective long-term follow-up study. J Am Coll Cardiol 2003;41:239–44.
Crossref | PubMed - Santinelli V, Radinovic A, Manguso F, et al. Asymptomatic ventricular preexcitation: A long-term prospective followup study of 293 adult patients. Circ Arrhythm Electrophysiol 2009;2:102–7.
Crossref | PubMed - Pappone C, Santinelli V, Manguso F, et al. A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome. N Engl J Med 2003;349:1803–11.
Crossref | PubMed - Pappone C, Vicedomini G, Manguso F, et al. Risk of malignant arrhythmias in initially symptomatic patients with Wolff- Parkinson-White syndrome: Results of a prospective long-term electrophysiological follow-up study. Circulation 2012;125:661–8.
Crossref | PubMed - Al-Khatib SM, Arshad A, Balk EM, et al. Risk stratification for arrhythmic events in patients with asymptomatic preexcitation: A systematic review for the 2015 ACC/AHA/ HRS guideline for the management of adult patients with supraventricular tachycardia: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2016;67:1624–38.
Crossref | PubMed - Pappone C, Manguso F, Santinelli R, et al. Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome. N Engl J Med 2004;351:1197–205.
Crossref | PubMed - Ammash NM, Phillips SD, Hodge DO, et al. Outcome of direct current cardioversion for atrial arrhythmias in adults with congenital heart disease. Int J Cardiol 2012;154:270–4.
Crossref | PubMed - Hoyer AW, Balaji S. The safety and efficacy of ibutilide in children and in patients with congenital heart disease. Pacing Clin Electrophysiol 2007;30:1003–8.
Crossref | PubMed - Murphy JG, Gersh BJ, McGoon MD, et al. Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years. N Engl J Med 1990;323:1645–50.
Crossref | PubMed - Konstantinides S, Geibel A, Olschewski M, et al. A comparison of surgical and medical therapy for atrial septal defect in adults. N Engl J Med 1995;333:469–73.
Crossref | PubMed - Wasmer K, Kobe J, Dechering DG, et al. Isthmus-dependent right atrial flutter as the leading cause of atrial tachycardias after surgical atrial septal defect repair. Int J Cardiol 2013;168:2447–52.
Crossref | PubMed - de Groot NM, Atary JZ, Blom NA, Schalij MJ. Long-term outcome after ablative therapy of postoperative atrial tachyarrhythmia in patients with congenital heart disease and characteristics of atrial tachyarrhythmia recurrences. Circ Arrhythm Electrophysiol 2010;3:148–54.
Crossref | PubMed - Yap SC, Harris L, Downar E, et al. Evolving electroanatomic substrate and intra-atrial reentrant tachycardia late after Fontan surgery. J Cardiovasc Electrophysiol 2012;23:339–45.
Crossref | PubMed - Yap SC, Harris L, Silversides CK, et al. Outcome of intraatrial re-entrant tachycardia catheter ablation in adults with congenital heart disease: Negative impact of age and complex atrial surgery. J Am Coll Cardiol 2010;56:1589–96
Crossref | PubMed - Wu J, Deisenhofer I, Ammar S, et al. Acute and long-term outcome after catheter ablation of supraventricular tachycardia in patients after the mustard or senning operation for d-transposition of the great arteries. Europace 2013;15:886–91.
Crossref | PubMed - Ueda A, Suman-Horduna I, Mantziari L, et al. Contemporary outcomes of supraventricular tachycardia ablation in congenital heart disease: A single-center experience in 116 patients. Circ Arrhythm Electrophysiol 2013;6:606–13.
Crossref | PubMed - Correa R, Walsh EP, Alexander ME, et al. Transbaffle mapping and ablation for atrial tachycardias after Mustard, Senning, or Fontan operations. J Am Heart Assoc 2013;2:e000325.
Crossref | PubMed - Khairy P, Harris L, Landzberg MJ, et al. Sudden death and defibrillators in transposition of the great arteries with intraatrial baffles: A multicenter study. Circ Arrhythm Electrophysiol 2008;1:250–7.
Crossref | PubMed - Koyak Z, Kroon B, de Groot JR, et al. Efficacy of antiarrhythmic drugs in adults with congenital heart disease and supraventricular tachycardias. Am J Cardiol. 2013;112:1461–7.
Crossref | PubMed - Feltes TF, Friedman RA. Transesophageal echocardiographic detection of atrial thrombi in patients with nonfibrillation atrial tachyarrhythmias and congenital heart disease. J Am Coll Cardiol 1994;24:1365–70.
Crossref | PubMed - Ghali WA, Wasil BI, Brant R, Exner DV, Cornuz J. Atrial flutter and the risk of thromboembolism: A systematic review and meta-analysis. Am J Med 2005;118:101–7.
Crossref | PubMed - Lafuente-Lafuente C, Valembois L, Bergmann JF, Belmin J. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev 2015;3:CD005049.
Crossref | PubMed - Fish FA, Gillette PC, Benson DW Jr. Proarrhythmia, cardiac arrest and death in young patients receiving encainide and flecainide. The pediatric electrophysiology group. J Am Coll Cardiol 1991;18:356–65.
Crossref | PubMed - Opic P, Yap SC, Van Kranenburg M, et al. Atrial-based pacing has no benefit over ventricular pacing in preventing atrial arrhythmias in adults with congenital heart disease. Europace 2013;15:1757–62.
Crossref | PubMed - Deal BJ, Mavroudis C, Backer CL, et al. Comparison of anatomic isthmus block with the modified right atrial maze procedure for late atrial tachycardia in Fontan patients. Circulation 2002;106:575–9.
Crossref | PubMed - Mavroudis C, Deal BJ, Backer CL, Tsao S. Arrhythmia surgery in patients with and without congenital heart disease. Ann Thorac Surg 2008;86:857–68.
Crossref | PubMed - Shivapour JK, Sherwin ED, Alexander ME, et al. Utility of preoperative electrophysiologic studies in patients with Ebstein’s anomaly undergoing the cone procedure. Heart Rhythm 2014;11:182–6.
Crossref | PubMed - Huang CJ, Chiu IS, Lin FY, et al. Role of electrophysiological studies and arrhythmia intervention in repairing Ebstein’s anomaly. Thorac Cardiovasc Surg 2000;48:347–50.
Crossref | PubMed - Cappato R, Schluter M, Weiss C, et al. Radiofrequency current catheter ablation of accessory atrioventricular pathways in Ebstein’s anomaly. Circulation. 1996;94:376–83.
Crossref | PubMed - Reich JD, Auld D, Hulse E, et al. The pediatric radiofrequency ablation registry’s experience with ebstein’s anomaly. Pediatric Electrophysiology Society. J Cardiovasc Electrophysiol 1998;9:1370–77
Crossref | PubMed - Tromp CH, Nanne AC, Pernet PJ, et al. Electrical cardioversion during pregnancy: Safe or not? Neth Heart J 2011;19:134–6.
Crossref | PubMed - Elkayam U, Goodwin TM. Adenosine therapy for supraventricular tachycardia during pregnancy. Am J Cardiol 1995;75:521–3.
Crossref | PubMed - Frishman WH, Chesner M. Beta-adrenergic blockers in pregnancy. Am Heart J 1988;115:147–52.
Crossref | PubMed - Ghosh N, Luk A, Derzko C, et al. The acute treatment of maternal supraventricular tachycardias during pregnancy: A review of the literature. J Obstet Gynaecol Can 2011;33:17–23.
Crossref | PubMed - Ersbøll AS, Hedegaard M, Søndergaard L, et al. Treatment with oral beta-blockers during pregnancy complicated by maternal heart disease increases the risk of fetal growth restriction. BJOG 2014;121:618–26.
Crossref | PubMed - Weber-Schoendorfer C, Hannemann D, Meister R, et al. The safety of calcium channel blockers during pregnancy: A prospective, multicenter, observational study. Reproductive Toxicology 2008;1:24–30.
Crossref | PubMed - Joglar JA, Page RL. Antiarrhythmic drugs in pregnancy. Curr Opin Cardiol 2001;16:40–5
Crossref | PubMed - Jaeggi ET, Carvalho JS, De Groot E, et al. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: Results of a nonrandomized multicenter study. Circulation 2011;124:1747–54.
Crossref | PubMed - Driver K, Chisholm CA, Darby AE, et al. Catheter ablation of arrhythmia during pregnancy. J Cardiovasc Electrophysiol 2015;26:698–702.
Crossref | PubMed - Lydakis C, Lip GY, Beevers M, Beevers DG. Atenolol and fetal growth in pregnancies complicated by hypertension. Am J Hypertens 1999;12:541–7.
Crossref | PubMed - Brugada P, Brugada J, Mont L, et al. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991;83:1649–59.
Crossref | PubMed - Vereckei A, Duray G, Szenasi G, et al. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm 2008;5:89–98.
Crossref | PubMed - Pava LF, Perafan P, Badiel M, et al. R-wave peak time at DII: a new criterion for differentiating between wide complex QRS tachycardias. Heart Rhythm 2010;7:922–6.
Crossref | PubMed