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........................ the culprit PV along with other PVs may be preferred. Catheter ablation is reported to have a 75100% success rate.184,187,194197

Table 11 presents a synopsis of success rates and complications of catheter ablation for the most common SVTs in the current era.1113,203208

11.1.2.4 Chronic therapy Studies addressing chronic therapy are also limited, and thus firm conclusions cannot be drawn. Beta-blockers and calcium channel blockers may be effective, and there is a low risk of side effects (Figure 9).188 Class IC drugs may be effective if first-line therapy has failed.189,190,198 Ivabradine may also be effective in focal AT,199,200 and ideally should be given with a beta-blocker. Amiodarone has been tried in the young and paediatric populations,201,202 and theoretically should be attractive in patients with impaired LV function. However, its long-term efficacy is limited by its side effects.

©ESC 2019

Focal AT

Adenosine

(IIa B)

i.v. ibutilde or flecainide or propafenone or amiodarone

(IIb C) Synchronized cardioversion

(I B)

Yes No

If ineffective

If ineffective

If ineffective

Haemodynamic

instability

i.v. verapamil or diltiazem

(IIa C) i.v. beta-blocker

(IIa C)

Figure 8 Acute therapy of focal atrial tachycardia. AT = atrial tachycardia; i.v. = intravenous. ©ESC 2019

Catheter ablation

(I B)

Beta-blocker or verapamil or diltiazem

or propafenone

or flecainide

(IIa C)

Ivabradine with a

beta-blocker

(IIb C)

Amiodarone

(IIb C)

No

No

Yes

Yes

If ineffective

If ineffective

If ineffective or not tolerated

Recurrent or

incessant

Drug therapy

desirable

Focal AT

Figure 9 Chronic therapy of focal atrial tachycardia. AT = atrial tachycardia.

Table 11 Average success and complication rates of catheter ablation for supraventricular tachycardia

Acute success (%) Recurrence (%) Complications (%) Mortality (%)

Focal AT 85 20 1.4a 0.1 Cavotricuspid-dependent atrial flutter 95 10 2b 0.2 AVNRT 97 2 0.3c 0.01 AVRT 92 8 1.5d 0.1 Success rates, recurrence, and complications for focal atrial tachycardia and atrioventricular re-entrant tachycardia vary, being dependent on the location of the focus or pathway, respectively.1113,203208 aVascular complications, AV block, and pericardial effusion. bVascular complications, stroke, myocardial infarction, and pericardial effusion. cVascular complications, AV block, and pericardial effusion. dVascular complications, AV block, myocardial infarction, pulmonary thromboembolism, and pericardial effusion. AT = atrial tachycardia; AV = atrioventricular; AVNRT = atrioventricular nodal re-entrant tachycardia; AVRT = atrioventricular re-entrant tachycardia. Downloaded from academic.oup.com/eurheartj/article/41/5/655/5556821 by guest on 07 October 2026