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Recommendations for the therapy of SVTs in congenital heart disease in adults Anticoagulation for focal AT or atrial flutter should be similar to patients with AF. I C Acute therapy Haemodynamically unstable patients Synchronized DC cardioversion is recommended for haemodynamically unstable patients. I B Haemodynamically stable patients Vagal manoeuvres, preferably in the supine position with leg elevation, are recommended. I B Adenosine (618 mg i.v. bolus) is recommended if vagal manoeuvres fail. I B Synchronized DC cardioversion is recommended when drug therapy fails to convert or control the tachycardia. I B

Recommendations for the therapy SVT in pregnancy Catheter ablation is recommended in symptomatic women with recurrent SVT who plan to become pregnant. I C Acute therapy Immediate electrical cardioversion is recommended for any tachycardia with haemodynamic instability. I C Vagal manoeuvres and, if these fail, adenosine are recommended for acute conversion of SVT. I C Chronic therapy During the first trimester of pregnancy it is recommended to avoid all antiarrhythmic drugs, if possible. I C

Recommendations for the therapy of SVT in patients with suspected or established heart failure due to tachycardiomyopathy Recommendation Classa Levelb Catheter ablation is recommended for tachycardiomyopathy due to SVT. I B Beta-blockers (from the list with proven mortality and morbidity benefits in HFrEF) are recommended for tachycardiomyopathy due to SVT, when catheter ablation fails or is not applicable. I A It is recommended to consider tachycardiomyopathy in patient with reduced LV ejection fraction with an elevated heart rate (>100 bpm). I B AV nodal ablation with subsequent pacing (“ablate and pace”), either biventricular or His-bundle pacing, is recommended if the tachycardia responsible for the tachycardiomyopathy cannot be ablated or controlled by drugs. I C

‘What not to do’ messages Recommendations for the acute management of wide QRS tachycardia in the absence of an established diagnosis Verapamil is not recommended in wide QRS-complex tachycardia of unknown aetiology. III B Recommendations for the therapy of MRATs Acute therapy Propafenone and flecainide are not recommended for conversion to sinus rhythm. III B Recommendations for the therapy of AVRT due to manifest or concealed APs Chronic therapy Digoxin, beta-blockers, diltiazem, verapamil, and amiodarone are not recommended and are potentially harmful in patients with pre-excited AF. III B Recommendations for the acute therapy of pre-excited AF Haemodynamically stable patients Amiodarone (i.v.) is not recommended. III B Recommendations for the therapy of SVTs in congenital heart disease in adults Chronic therapy Sotalol is not recommended as a first-line antiarrhythmic drug as it is related to an increased risk of pro-arrhythmias and mortality. III C Flecainide and propafenone are not recommended as first-line antiarrhythmic drugs in patients with ventricular dysfunction and severe fibrosis. III C Recommendations for the therapy of SVT in pregnancy Chronic therapy Amiodarone is not recommended in pregnant women. III C

AF = atrial fibrillation; AP = accessory pathway; AT = atrial tachycardia; AVNRT = atrioventricular nodal re-entrant tachycardia; AVRT = atrioventricular re-entrant tachycardia; CTI = cavotricuspid isthmus; DC = direct current; ECG = electrocardiogram; EPS = electrophysiology study; ERP = effective refractory period; HF = heart failure; i.v. = intravenous; MRAT = macro-re-entrant atrial tachycardia; SPERRI = shortest pre-excited RR interval during atrial fibrillation; SVT = supraventricular tachycardia; TCM = tachycardiomyopathy. aClass of recommendation. bLevel of evidence. Downloaded from academic.oup.com/eurheartj/article/41/5/655/5556821 by guest on 07 October 2026