Supraventricular tachycardia AHA recommendations for Management of SVT in Pregnant Patients

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2015 ACC/AHA Guideline Recommendations

Acute Treatment of SVT of Unknown Mechanism
Ongoing Management of SVT of Unknown Mechanism
Ongoing Management of IST
Acute Treatment of Suspected Focal Atrial Tachycardia
Acute Treatment of Multifocal Atria Tachycardia
Ongoing Management of Multifocal Atrial Tachycardia
Acute Treatment of AVNRT
Ongoing Management of AVNRT
Acute Treatment of Orthodromic AVRT
Ongoing Management of Orthodromic AVRT
Asymptomatic Patients With Pre-Excitation
Management of Symptomatic Patients With Manifest Accessory Pathways
Acute Treatment of Atrial Flutter
Ongoing Management of Atrial Flutter
Acute Treatment of Junctional Tachycardia
Ongoing Management of Junctional Tachycardia
Acute Treatment of SVT in ACHD Patients
Ongoing Management of SVT in ACHD Patients
Acute Treatment of SVT in Pregnant Patients
Acute Treatment and Ongoing Management of SVT in Older Population

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

Vagal maneuvers, adenosine, and synchronized cardioversion is recommended for acute treatment in pregnant patients with SVT. Digoxinflecainide, metoprolol, propafenone, propranolol, sotalol, and verapamil alone or in combination, can be effective for ongoing management in pregnant patients with highly symptomatic SVT. Catheter ablation may be reasonable in pregnant patients with highly symptomatic, recurrent, drug-refractory SVT with efforts toward minimizing radiation exposure. Oral amiodarone may be considered for ongoing management in pregnant patients when treatment of highly symptomatic, recurrent SVT is required and other therapies are ineffective or contraindicated.[1]

Management of SVT in Pregnant Patients

2015 AHA recommendations for the acute and ongoing management of SVT in pregnant patients are described below:[1]

Acute treatment of SVT in pregnant patient

Class I
"1. Vagal maneuvers are recommended for acute treatment in pregnant patients with SVT "(Level of Evidence:C-LD ) "
"2. Adenosine is recommended for acute treatment in pregnant patients with SVT "(Level of Evidence:C-LD ) "
"3. Synchronized cardioversion is recommended for acute treatment in pregnant patients with hemodynamically unstable SVT when pharmacological therapy is ineffective or contraindicated "(Level of Evidence:C-LD ) "
Class IIa
"1.bIntravenous metoprolol or propranolol is reasonable for acute treatment in pregnant patients with SVT when adenosine is ineffective or contraindicated "(Level of Evidence:C-LD ) "
Class IIb
"1. Intravenous verapamil may be reasonable for acute treatment in pregnant patients with SVT when adenosine and beta blockers are ineffective or contraindicated"(Level of Evidence:C-LD) "
"2. Intravenous procainamide may be reasonable for acute treatment in pregnant patients with SV "(Level of Evidence:C-LD) "
"3. Intravenous amiodarone may be considered for acute treatment in pregnant patients with potentially lifethreatening SVT when other therapies are ineffective or contraindicated "(Level of Evidence:C-LD) "

Management of ongoing SVT in Pregnant Patients

Class IIa
"1. The following drugs, alone or in combination, can be effective for ongoing management in pregnant patients with highly symptomatic SVT:

a. Digoxin, b. Flecainide, c. Metoprolol, d. Propafenone, e. Propranolol, f. Sotalol, g. Verapamil"(Level of Evidence:C-LD) "

Class IIb
"1. Catheter ablation may be reasonable in pregnant patients with highly symptomatic, recurrent, drug-refractory SVT with efforts toward minimizing radiation exposure "(Level of Evidence:C-LD) "
"2. Oral amiodarone may be considered for ongoing management in pregnant patients when treatment of highly symptomatic, recurrent SVT is required and other therapies are ineffective or contraindicated "(Level of Evidence:C-LD) "

References

  1. 1.0 1.1 Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ; et al. (2016). "2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society". J Am Coll Cardiol. 67 (13): e27–e115. doi:10.1016/j.jacc.2015.08.856. PMID 26409259.