ESC 2019 2019 ESC Guidelines for the management of patients with supraventricular tachycardia
European Society of Cardiology｜循環器 / 不整脈｜66 ページ｜チャンク 625｜推奨 160 件｜current
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| 頁 | クラス | レベル | 推奨文 | 表 |
|---|---|---|---|---|
| p.16 | I | B | mended if vagal manoeuvres fail.9294 | |
| p.16 | I | B | Haemodynamically unstable patients Synchronized DC cardioversion is recom- mended for haemodynamically unstable patients.8688 | |
| p.16 | I | C | Haemodynamically stable patients A 12 lead ECG during tachycardia is recommended. | |
| p.16 | I | B | Vagal manoeuvres, preferably in the supine position with leg elevation, are recommended.41,8991 Adenosine (618 mg i.v. bolus) is recom- | |
| p.16 | IIa | B | Verapamil or diltiazem (i.v.) should be consid- ered, if vagal manoeuvres and adenosine fail.92,9498 | |
| p.16 | IIa | C | Beta-blockers (i.v. esmolol or metoprolol) should be considered if vagal manoeuvres and adenosine fail.97,99,100 | |
| p.16 | I | B | Synchronized direct-current cardioversion is recommended when drug therapy fails to con- vert or control the tachycardia.87,88 | |
| p.18 | I | B | in haemodynamically unstable patients.86,130 | |
| p.18 | IIa | B | vagal manoeuvres and adenosine fail.132 | |
| p.18 | IIb | B | manoeuvres and adenosine fail.132 | |
| p.18 | I | C | Haemodynamically unstable patients Synchronized DC cardioversion is recommended Haemodynamically stable patients A 12 lead ECG during tachycardia is recommended. | |
| p.18 | I | C | Vagal manoeuvres, preferably in the supine position with leg elevation, are recommended. | |
| p.18 | IIa | C | Adenosine should be considered if vagal manoeuvres fail and there is no pre-excitation on a resting ECG. Procainamide (i.v.) should be considered if | |
| p.18 | I | B | Amiodarone (i.v.) may be considered if vagal Synchronized DC cardioversion is recom- mended if drug therapy fails to convert or control the tachycardia.86,130 | |
| p.18 | III | B | Verapamil is not recommended in wide QRScomplex tachycardia of unknown aetiology.64,133,134 | |
| p.20 | I | C | Evaluation and treatment of reversible causes is recommended.139,144,162 | |
| p.20 | IIa | C | tomatic patients.139,147 | |
| p.20 | IIa | B | A regular and progressive exercise programme should be considered.167169 | |
| p.20 | IIb | C | Ivabradine may be considered.175 | |
| p.20 | IIa | B | Inappropriate sinus tachycardia Ivabradine alone or in combination with a beta-blocker should be considered in sympto- matic patients.146149,151,152 Beta-blockers should be considered in symp- | |
| p.20 | IIb | C | Sinus nodal re-entrant tachycardia Non-dihydropyridine calcium channel blockers (verapamil or diltiazem) in the absence of HFrEF, may be considered in symptomatic patients.163 | |
| p.20 | IIa | C | Catheter ablation should be considered in symptomatic patients who do not respond to drug therapy.164166 Postural orthostatic tachycardia syndrome | |
| p.20 | IIb | C | The consumption of >_23 L of water and 1012 g of sodium chloride daily may be considered.170,171 | |
| p.20 | IIb | B | Midodrine, low-dose non-selective beta- blocker, or pyridostigmine may be considered.167,170,172174 HFrEF = heart failure with reduced ejection fraction. aClass of recommendation. bLevel of evidence. | |
| p.22 | I | B | Synchronized DC cardioversion is recommended for haemodynamically unstable patients.8688 | |
| p.22 | IIa | B | Adenosine (618 mg i.v. bolus) should be considered.9294 | |
| p.22 | IIa | C | Beta-blockers (i.v. esmolol or metoprolol) should be considered in the absence of decompensated HF, if adenosine fails.187,188 | |
| p.22 | IIa | C | if adenosine fails.92,94 | |
| p.22 | I | B | Synchronized DC cardioversion is recommended when drug therapy fails to convert or control the tachycardia.87,88 | |
| p.22 | I | B | Catheter ablation is recommended for recurrent focal AT, especially if incessant or causing TCM.184,187,194197 | |
| p.22 | IIa | C | Beta-blockers or non-dihydropyridine calcium channel blockers (verapamil or diltiazem in the absence of HFrEF), or propafenone or flecainide in the absence of structural or ischaemic heart disease, should be considered if ablation is not desirable or feasible.188190,198 | |
| p.22 | IIb | C | Ivabradine with a beta-blocker may be considered if the above measures fail.199,200 | |
| p.22 | IIb | C | Amiodarone may be considered if the above measures fail.201,202 | |
| p.24 | I | C | Treatment of an underlying condition is recommended as a first step, if feasible.209 | |
| p.24 | IIa | B | Acute therapy i.v. beta-blockers, or i.v. non-dihydropyridine calcium channel blockers (verapamil or diltia- zem) should be considered.213,214 | |
| p.24 | IIa | B | Chronic therapy Oral verapamil or diltiazem should be consid- ered for patients with recurrent symptomatic multifocal AT in the absence of HFrEF.217,218 | |
| p.24 | IIa | B | A selective beta-blocker should be considered for patients with recurrent symptomatic multi- focal AT.214,219 | |
| p.24 | IIa | C | AV nodal ablation followed by pacing (preferable biventricular or His-bundle pacing) should be considered for patients with LV dysfunction due to recurrent multifocal AT refractory to drug therapy.216 | |
| p.25 | I | B | Anticoagulation, as in AF, is recommended for patients with atrial flutter and concomitant AF.4 | |
| p.25 | IIa | C | established.241247 | |
| p.25 | I | B | Synchronized DC cardioversion is recommended for haemodynamically unstable patients.248,249 | |
| p.25 | I | B | i.v. ibutilide or i.v. or oral (in-hospital) dofetilide are recommended for conversion to sinus rhythm.250257 | |
| p.25 | I | B | Low-energy (<_100 J biphasic) electrical cardioversion is recommended for conversion to sinus rhythm.248,249 | |
| p.25 | I | B | High-rate atrial pacing is recommended for termination of atrial flutter in the presence of an implanted pacemaker or defibrillator.258260 | |
| p.25 | IIa | B | rapid ventricular rate.235238 | |
| p.25 | IIb | B | Invasive and non-invasive high-rate atrial pacing may be considered for termination of atrial flutter.258,261 | |
| p.25 | IIb | C | i.v. amiodarone may be tried if the above are not available or desirable.239,240 | |
| p.25 | III | B | Propafenone and flecainide are not recommended for conversion to sinus rhythm.250 | |
| p.25 | IIa | B | Catheter ablation should be considered after the first episode of symptomatic typical atrial flutter.262,263 | |
| p.25 | I | A | Catheter ablation is recommended for symptomatic, recurrent episodes of CTI-dependent flutter.262264 | |
| p.25 | I | B | Catheter ablation in experienced centres is recommended for symptomatic, recurrent episodes of non-CTI-dependent flutter.224,265269 | |
| p.25 | I | B | to TCM.233,234 | |
| p.25 | IIa | C | Beta-blockers or non-dihydropyridine calcium channel blockers (verapamil or diltiazem, in the absence HFrEF) should be considered if ablation is not desirable or feasible.237,270 | |
| p.25 | IIb | C | Amiodarone may be considered to maintain sinus rhythm if the above measures fail.263 | |
| p.30 | I | B | Synchronized DC cardioversion is recommended for haemodynamically unstable patients.8688 | |
| p.30 | I | B | tion with leg elevation, are recommended.41,8991 | |
| p.30 | I | B | Adenosine (618 mg i.v. bolus) is recommended if vagal manoeuvres fail.9294 | |
| p.30 | IIa | B | vagal manoeuvres and adenosine fail.92,9498 | |
| p.30 | IIa | C | Acute therapy Haemodynamically unstable patients Haemodynamically stable patients Vagal manoeuvres, preferably in the supine posi- Verapamil or diltiazem i.v. should be considered if Beta-blockers (i.v. esmolol or metoprolol) should be considered if vagal manoeuvres and adenosine fail.97,99,100 | |
| p.30 | I | B | Synchronized DC cardioversion is recommended when drug therapy fails to convert or control the tachycardia.87,88 | |
| p.31 | I | B | matic, recurrent AVNRT.208,336339 | |
| p.31 | IIa | B | Chronic therapy Catheter ablation is recommended for sympto- Diltiazem or verapamil, in patients without HFrEF, or beta-blockers should be considered if ablation is not desirable or feasible.340342 | |
| p.31 | IIa | C | Abstinence from therapy should be considered for minimally symptomatic patients with very infrequent, short-lived episodes of tachycardia.319 AVNRT | |
| p.36 | I | B | Synchronized DC cardioversion is recommended for haemodynamically unstable patients.8688 | |
| p.36 | I | B | Vagal manoeuvres, preferably in the supine position with leg elevation, are recommended.41,8991 | |
| p.36 | I | B | orthodromic.9294 | |
| p.36 | IIa | B | In orthodromic AVRT, i.v. verapamil or diltiazem should be considered if vagal manoeuvres and adenosine fail.92,9498 | |
| p.36 | IIa | C | In orthodromic AVRT, i.v. beta-blockers (esmolol or metoprolol) should be considered in the absence of decompensated HF, if vagal manoeuvres and adenosine fail.97,99,100 | |
| p.36 | IIa | B | considered if vagal manoeuvres and adenosine fail.421,422,429,437 | |
| p.36 | IIb | B | In antidromic AVRT, i.v. amiodarone may be considered in refractory cases.423425,435 | |
| p.36 | I | B | Synchronized DC cardioversion is recommended when drug therapy fails to convert or control the tachycardia.87,88 | |
| p.36 | I | B | Catheter ablation of AP(s) is recommended in patients with symptomatic, recurrent AVRT.391393,438441 | |
| p.36 | IIa | B | ered if no signs of pre-excitation are present on resting ECG, if ablation is not desirable or feasible.340,341,442,443 | |
| p.36 | IIb | B | is not desirable or feasible.429,444,445 | |
| p.36 | III | B | pre-excited AF.427,428,432434,446 | |
| p.37 | I | B | Synchronized DC cardioversion is recommended in haemodynamically unstable patients.86,130 | |
| p.37 | IIa | B | Ibutilide or procainamide (i.v.) should be considered.421,430,436 | |
| p.37 | IIb | B | Flecainide or propafenone (i.v.) may be considered.429,431 | |
| p.37 | I | B | Synchronized DC cardioversion is recommended if drug therapy fails to convert or control the tachycardia.86,130 | |
| p.37 | III | B | Amiodarone (i.v.) is not recommended.432435 | |
| p.39 | I | B | Performance of an EPS, with the use of isopre- naline, is recommended to risk stratify individuals with asymptomatic pre-excitation who have high-risk occupations/hobbies,c and those who participate in competitive athletics.439,450452,454460 | |
| p.39 | I | B | Catheter ablation is recommended in asymp- tomatic patients in whom electrophysiology testing with the use of isoprenaline identifies high-risk properties, such as SPERRI <_250 ms, AP ERP <_250 ms, multiple APs, and an inducible AP-mediated tachycardia.439,450,452,454460 | |
| p.39 | I | C | Catheter ablation is recommended in high-risk patients with asymptomatic pre-excitation after discussing the risks, especially of heart block associated with ablation of anteroseptal or MS APs, and benefits of the | |
| p.39 | IIa | B | procedure.439,440,473476 Performance of an EPS to risk stratify individu- als with asymptomatic pre-excitation should be considered.439,450452,454460 | |
| p.39 | IIb | B | Non-invasive evaluation of the conducting properties of the AP in individuals with asymp- tomatic pre-excitation may be considered.459,461463,465469 | |
| p.39 | I | C | Invasive risk stratification with an EPS is rec- ommended in patients without ‘low-risk’ char- acteristics at non-invasive risk stratification.462,463,465469,477 | |
| p.39 | IIa | C | Clinical follow-up should be considered in a patient with asymptomatic pre-excitation and a low-risk AP at invasive risk stratification.450,452,456,463,477 | |
| p.39 | IIb | C | Catheter ablation may be considered in a patient with asymptomatic pre-excitation, and a low-risk AP at invasive or non-invasive risk stratification.405,450,452,456,463,477 | |
| p.39 | IIa | C | Catheter ablation should be considered in patients with asymptomatic pre-excitation and LV dysfunction due to electrical dyssynchrony.478481 | |
| p.39 | IIb | C | Catheter ablation may be considered in patients with low-risk asymptomatic pre-exci- tation in appropriately experienced centres according to patient preferences.203,439,450,453,454,471,474,482 | |
| p.42 | I | C | Anticoagulation for focal AT or atrial flutter should be similar to that for patients with AF.241,242,499 | |
| p.42 | I | B | Synchronized DC cardioversion is recommended for haemodynamically unstable patients.8688,491,492 | |
| p.42 | I | B | Vagal manoeuvres, preferably in the supine position with leg elevation, are recommended.41,8991 | |
| p.42 | I | B | Adenosine (618 mg i.v. bolus) is recommended if vagal manoeuvres fail.9294 | |
| p.42 | IIa | B | i.v. verapamil or diltiazem should be considered, if vagal manoeuvres and adenosine fail.92,9498 | |
| p.42 | IIa | C | i.v. beta-blockers esmolol or metoprolol) should be considered if vagal manoeuvres and adenosine fail.97,99,100 | |
| p.42 | I | B | Synchronized DC cardioversion is recommended when drug therapy fails to convert or control the tachycardia.87,88 | |
| p.42 | IIa | C | Catheter ablation in experienced centres should be considered.292,500,501 | |
| p.42 | IIa | C | Beta-blockers should be considered for recurrent focal AT or atrial flutter, if ablation is not possible or successful.237 | |
| p.42 | IIa | C | tive surgical ablation should be considered.502504 | |
| p.42 | IIb | C | Amiodarone may be considered for prevention if ablation is not possible or successful.505 | |
| p.42 | III | C | Sotalol is not recommended as a first-line antiarrhythmic drug as it is related to an increased risk of pro-arrhythmias and mortality.496 | |
| p.42 | III | C | Flecainide and propafenone are not recommended as first-line antiarrhythmic drugs in patients with ventricular dysfunction and severe fibrosis.497 | |
| p.44 | I | C | Catheter ablation is recommended in symptomatic women with recurrent SVT who plan to become pregnant.538 | |
| p.44 | I | C | Immediate electrical cardioversion is recommended for any tachycardia with haemodynamic instability.539,540 | |
| p.44 | I | C | Vagal manoeuvres and, if these fail, adenosine are recommended for acute conversion of SVT.541,542 | |
| p.44 | IIa | C | An i.v. beta-1 selective blocker (except atenolol) should be considered for acute conversion or rate control of SVT.542,543 | |
| p.44 | IIa | C | i.v. digoxin in the latest pocket Gls version should be considered for rate control of AT if beta-blockers fail.542,543 | |
| p.44 | IIb | C | i.v. ibutilide in the latest pocket Gls version may be considered for termination of atrial flutter.544,545 | |
| p.44 | I | C | During the first trimester of pregnancy, it is recommended that all antiarrhythmic drugs should be avoided, if possible. | |
| p.44 | IIa | C | SVT in patients without WPW syndrome.543,546548 | |
| p.44 | IIa | C | Flecainide or propafenone should be considered for prevention of SVT in patients with WPW syndrome, and without ischaemic or structural heart disease.549 | |
| p.44 | IIa | C | agents fail to prevent SVT.533,543 | |
| p.44 | IIa | C | Digoxin or verapamil should be considered for rate control of AT if beta-blockers fail in patients without WPW syndrome.543 | |
| p.44 | III | C | Amiodarone is not recommended in pregnant women.153,543 | |
| p.44 | IIa | C | centres.550552 | |
| p.45 | I | B | Catheter ablation is recommended for TCM due to SVT.196,233,418,525 | |
| p.45 | I | A | 15.4 Therapy Beta-blockers (from the list with proved mor- tality and morbidity benefits in HFrEF) are rec- ommended for TCM due to SVT, when catheter ablation fails or is not applicable.567 | |
| p.45 | I | B | It is recommended that TCM is considered in a patient with reduced LV ejection fraction with an elevated heart rate (>100 b.p.m.).557561 | |
| p.45 | IIa | B | 24 h (or multiday) ambulatory ECG monitor- ing should be considered for diagnosis of TCM by identifying subclinical or intermittent arrhythmias.526,557,568 | |
| p.45 | I | C | AV nodal ablation with subsequent pacing (‘ablate and pace’), either biventricular or His- bundle pacing, is recommended if the tachy- cardia responsible for the TCM cannot be ablated or controlled by drugs.526,557,564,569572 | |
| p.48 | I | B | Synchronized direct-current cardioversion is recommended for haemodynamically unstable patients. | |
| p.48 | I | C | A 12-lead ECG during tachycardia is recommended. | |
| p.48 | I | B | Vagal manoeuvres, preferably in the supine position with leg elevation, are recommended. | |
| p.48 | I | B | Adenosine (618 mg i.v. bolus) is recommended if vagal manoeuvres fail. | |
| p.48 | I | B | Synchronized direct-current cardioversion is recommended when drug therapy fails to convert or control the tachycardia. | |
| p.48 | I | B | Synchronized direct-current cardioversion is recommended in haemodynamically unstable patients. | |
| p.48 | I | C | Vagal manoeuvres, preferably in the supine position with leg elevation, are recommended. | |
| p.48 | I | B | Synchronized direct-current cardioversion is recommended if drug therapy fails to convert or control the tachycardia. | |
| p.48 | I | C | Evaluation and treatment of reversible causes is recommended.139,144,162 | |
| p.48 | I | B | Synchronized DC cardioversion is recommended for haemodynamically unstable patients. | |
| p.48 | I | B | Synchronized DC cardioversion is recommended when drug therapy fails to convert or control the tachycardia. | |
| p.48 | I | B | Catheter ablation is recommended for recurrent focal AT, especially if incessant or causing tachycardiomyopathy. | |
| p.48 | I | C | Treatment of an underlying condition is recommended as a first step, if feasible. | |
| p.49 | I | B | Anticoagulation as in AF is recommended for patients with atrial flutter and concomitant AF. | |
| p.49 | I | B | Synchronized DC cardioversion is recommended for haemodynamically unstable patients. | |
| p.49 | I | B | Low-energy (<_100 J biphasic) electrical cardioversion is recommended for conversion to sinus rhythm. | |
| p.49 | I | A | Catheter ablation is recommended for symptomatic, recurrent episodes of cavotricuspid isthmus-dependent flutter. | |
| p.49 | I | B | Catheter ablation in experienced centres is recommended for symptomatic, recurrent episodes of non-CTI-dependent flutter. | |
| p.49 | I | B | Vagal manoeuvres, preferably in the supine position with leg elevation, are recommended.41, 89-91 | |
| p.49 | I | B | Adenosine (618 mg i.v. bolus) is recommended if vagal manoeuvres fail.92-94 | |
| p.49 | I | B | Synchronized DC cardioversion is recommended when drug therapy fails to convert or control the tachycardia.87, 88 | |
| p.49 | I | B | Catheter ablation is recommended for symptomatic, recurrent AVNRT.208, 336-339 | |
| p.49 | I | B | Catheter ablation of AP(s) is recommended in patients with symptomatic, recurrent AVRT. | |
| p.49 | I | B | Synchronized DC cardioversion is recommended in haemodynamically unstable patients. | |
| p.49 | I | B | Synchronized DC cardioversion is recommended if drug therapy fails to convert or control the tachycardia. | |
| p.50 | I | C | Anticoagulation for focal AT or atrial flutter should be similar to patients with AF. | |
| p.50 | I | B | Synchronized DC cardioversion is recommended for haemodynamically unstable patients. | |
| p.50 | I | B | Vagal manoeuvres, preferably in the supine position with leg elevation, are recommended. | |
| p.50 | I | B | Adenosine (618 mg i.v. bolus) is recommended if vagal manoeuvres fail. | |
| p.50 | I | B | Synchronized DC cardioversion is recommended when drug therapy fails to convert or control the tachycardia. | |
| p.50 | I | C | Catheter ablation is recommended in symptomatic women with recurrent SVT who plan to become pregnant. | |
| p.50 | I | C | Immediate electrical cardioversion is recommended for any tachycardia with haemodynamic instability. | |
| p.50 | I | C | Vagal manoeuvres and, if these fail, adenosine are recommended for acute conversion of SVT. | |
| p.50 | I | C | During the first trimester of pregnancy it is recommended to avoid all antiarrhythmic drugs, if possible. | |
| p.50 | I | B | Catheter ablation is recommended for tachycardiomyopathy due to SVT. | |
| p.50 | III | B | Verapamil is not recommended in wide QRS-complex tachycardia of unknown aetiology. | |
| p.50 | III | B | Propafenone and flecainide are not recommended for conversion to sinus rhythm. | |
| p.50 | III | B | Amiodarone (i.v.) is not recommended. | |
| p.50 | III | C | Amiodarone is not recommended in pregnant women. |