The 2019 ESC Guidelines for the Management of Patients with
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Supraventricular tachycardia is a rapid heartbeat that develops when the normal electrical impulses of the heart are disrupted.
There may be symptoms like heart palpitations or there may be no symptoms at all.

The Ten Commandments for 2019 ESC Guidelines on
Supraventricular Arrhythmias:

1. Start with vagal manoeuvres and adenosine in the acute evaluation and management of patients with sustained forms of SVT.

2. Supraventricular tachycardias may present as a wide complex tachycardia due to concomitant BBB, drug-induced conduction slowing, antegrade conduction of an AP, or an atrial sensed ventricular paced rhythm. Despite this fact, wide complex tachycardias should be considered to be caused by ventricular tachycardia until proved otherwise.

3. Cardioversion is the preferred initial treatment strategy for SVT patients who are haemodynamically unstable.

4. Catheter ablation is the preferred treatment strategy for almost all patients with symptomatic SVTs, with the exception of pregnant patients in the first trimester and also patients with inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome, and multifocal atrial tachycardia.

5. Patients with both atrial flutter and AF should be anticoagulated according to the AF anticoagulation guidelines. Long-term anticoagulation in patients with atrial flutter alone, should be considered for anticoagulation but the threshold for initiation anticoagulation has not been well-established.

6. Patients with asymptomatic pre-excitation who are competitive athletes should undergo EPS with isoproterenol for risk stratification. If a ‘high risk’ AP is identified catheter ablation is recommended.

7. Patients with pre-excitation who are asymptomatic and who are not competitive athletes may consider either an EPS for risk stratification (Class 2A, LOE B), or non-invasive risk stratification (Class 2B, LOE C).

8. Catheter ablation can be considered for patients with asymptomatic pre-excitation who have ‘low risk’ APs provided the procedure is performed at an experienced centre and after careful consideration of the patient’s preferences.

9. Avoid antiarrhythmic drugs during the first trimester of pregnancy.

10. Catheter ablation is recommended for treatment of patients with tachycardia-induced cardiomyopathy.

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