p.52 抽出テキスト
antiarrhythmic drugs for SVT have been limited, and data are often extrapolated from studies that primarily focused on management of patients with AF. The efficacy of a variety of drugs is likely to differ according to the tachycardia mechanism, and therefore differentiating the best drug for each individual arrhythmia is necessary; for example, the efficacy of class III agents might be markedly different in patients with AF than in patients with atrial flutter. Limited data exist on the optimal management of less common types of SVTs, such as junctional tachycardia and multifocal AT. Therefore, in view of significant gaps that remain with regard to optimal management of patients with SVT, we must consider the role of electronic medical records, registries, and national datasets to better acquire observational data when trials are not available or feasible. Multicenter registry studies would allow for expansion of our knowledge on the best pharmacological and nonpharmacological approaches to treat these arrhythmias. In collaboration with national societies, the National Institutes of Health, and the US Food and Drug Administration, registries could be developed across selected centers to gather important information on safety and longterm outcomes where data are lacking (just as such registries are being developed for AF ablation). Mandatory postmarket surveillance data collection on new drugs for SVT could also be considered by the US Food and Drug Administration as a condition for drug approval. The mechanism and primary etiology of IST remains to be defined—advances here would provide a first step on finding better therapies for this disorder. It should be noted that medical advances have resulted in an increase in the number of patients with SVT in specific populations, such as in patients after ablation (especially AF), ACHD patients, and patients of advanced age. As the numbers of these often-complicated patients grow, opportunities arise to perform clinical research to guide future recommendations. New pharmacological therapies are needed, especially for SVT in patients for whom ablation is not an option or has been unsuccessful. Newer drugs that selectively target atrial channels currently under investigation for patients with AF should be investigated for management of AT. Both mapping and ablation techniques need to be further investigated to maximize the likelihood of successful ablation with minimal risk. In the outpatient setting, the added value of new personal monitoring and implantable devices needs to be assessed, and studies of the impact of shared decision making with patients on outcomes are needed for personal monitoring innovations. Finally, we encourage investigation of quality-of-life improvement strategies, in addition to cost-effectiveness studies, for the management of SVT. Presidents and Staff American College of Cardiology Kim A. Williams, Sr, MD, FACC, FAHA, President Shalom Jacobovitz, Chief Executive Officer William J. Oetgen, MD, MBA, FACC, Executive Vice President, Science, Education, and Quality Amelia Scholtz, PhD, Publications Manager, Science, Education, and Quality American College of Cardiology/American Heart Association Lisa Bradfield, CAE, Director, Guidelines and Clinical Policy Abdul R. Abdullah, MD, Associate Science and Medicine Advisor Alexa Papaila, Project Manager, Science and Clinical Policy American Heart Association Mark A. Creager, MD, FACC, FAHA, President Nancy Brown, Chief Executive Officer Rose Marie Robertson, MD, FAHA, Chief Science Officer Gayle R. Whitman, PhD, RN, FAHA, FAAN, Senior Vice President, Office of Science Operations Marco Di Buono, PhD, Vice President, Science, Research, and Professional Education Jody Hundley, Production Manager, Scientific Publications, Office of Science Operations Acknowledgments We thank Dr. Daniel B. Mark for his invaluable assistance in reviewing studies relating to quality of life and cost-effectiveness. His research and insight informed much of the discussion on these topics. We also thank Dr. Sarah A. Spinler for her contributions with regard to antiarrhythmic drug therapy. References 1. Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Institute of Medicine (US). Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Press, 2011. 2. Committee on Standards for Systematic Reviews of Comparative Effectiveness Research, Institute of Medicine (US). Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: National Academies Press, 2011. 3. ACCF/AHA Task Force on Practice Guidelines. Methodology Manual and Policies From the ACCF/AHA Task Force on Practice Guidelines. American College of Cardiology and American Heart Association. 2010. Available at: http://assets.cardiosource.com/Methodology_Manual_ for_ACC_AHA_Writing_Committees.pdf and http://my.americanheart. org/idc/groups/ahamah-public/@wcm/@sop/documents/downloadable/ ucm_319826.pdf. Accessed January 23, 2015. 4. Jacobs AK, Kushner FG, Ettinger SM, et al. ACCF/AHA clinical practice guideline methodology summit report: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:268–310. 5. Jacobs AK, Anderson JL, Halperin JL. The evolution and future of ACC/ AHA clinical practice guidelines: a 30-year journey: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:1208–17. 6. Anderson JL, Heidenreich PA, Barnett PG, et al. ACC/AHA statement on cost/value methodology in clinical practice guidelines and performance measures: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and Task Force on Practice Guidelines. Circulation. 2014;129:2329–45. 7. Halperin JL, Levine GN, Al-Khatib SM. Further evolution of the ACC/ AHA clinical practice guideline recommendation classification system: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2016;133:1426–28. 8. Arnett DK, Goodman RA, Halperin JL, et al. AHA/ACC/HHS strategies to enhance application of clinical practice guidelines in patients with cardiovascular disease and comorbid conditions: from the American Heart Association, American College of Cardiology, and US Department of Health and Human Services. Circulation. 2014;130:1662–7. 9. Al-Khatib SM, Arshad A, Balk EM et al. Risk stratification for arrhyth- mic events in patients with asymptomatic pre-excitation: a systematic review for the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American Downloaded from http://ahajournals.org by on October 7, 2026