Supraventricular tachycardia AHA recommendations for Management of SVT in Pregnant Patients: Difference between revisions

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Latest revision as of 17:04, 27 October 2016

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. Digoxin flecainide, 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

↑ ^1.0 ^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.

[pmid26409259-1] 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.

[1]

@@ Line 3: / Line 3: @@
 {{CMG}} {{AE}}{{AA}}
 ==Overview==
+[[Vagal maneuvers]], [[adenosine]], and [[synchronized cardioversion]] is recommended for acute treatment in pregnant patients with SVT. [[Digoxin]][[flecainide]], [[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.<ref name="pmid26409259">{{cite journal| author=Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ et al.| title=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. | journal=J Am Coll Cardiol | year= 2016 | volume= 67 | issue= 13 | pages= e27-e115 | pmid=26409259 | doi=10.1016/j.jacc.2015.08.856 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26409259  }} </ref>
 ==Management of SVT in Pregnant Patients==
+AHA recommendations for the acute and ongoing management of SVT in pregnant patients are described below:<ref name="pmid26409259">{{cite journal| author=Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ et al.| title=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. | journal=J Am Coll Cardiol | year= 2016 | volume= 67 | issue= 13 | pages= e27-e115 | pmid=26409259 | doi=10.1016/j.jacc.2015.08.856 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26409259  }} </ref>
 ===Acute treatment of SVT in pregnant patient===
 {|class="wikitable" style="width:80%"
@@ Line 9: / Line 11: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''Vagal maneuvers are recommended for acute treatment in pregnant patients with SVT <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD ]])'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Vagal maneuvers]] are recommended for acute treatment in pregnant patients with SVT <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD ]])'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''Adenosine is recommended for acute treatment in pregnant patients with SVT <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD ]])'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Adenosine]] is recommended for acute treatment in pregnant patients with SVT <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD ]])'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''Synchronized cardioversion is recommended for acute treatment in pregnant patients with hemodynamically unstable SVT when pharmacological therapy is ineffective or contraindicated <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD ]])'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Synchronized cardioversion]] is recommended for acute treatment in pregnant patients with hemodynamically unstable SVT when pharmacological therapy is ineffective or contraindicated <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD ]])'' <nowiki>"</nowiki>
 |}
@@ Line 23: / Line 24: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''Intravenous metoprolol or propranolol is reasonable for acute treatment in pregnant patients with SVT when
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''bIntravenous [[metoprolol]] or [[propranolol]] is reasonable for acute treatment in pregnant patients with SVT when adenosine is ineffective or contraindicated <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD ]])'' <nowiki>"</nowiki>
-adenosine is ineffective or contraindicated <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD ]])'' <nowiki>"</nowiki>
 |}
@@ Line 31: / Line 31: @@
 | colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''Intravenous verapamil may be reasonable for acute treatment in pregnant patients with SVT when adenosine and
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intravenous [[verapamil]] may be reasonable for acute treatment in pregnant patients with SVT when adenosine and beta blockers are ineffective or contraindicated<nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
-beta blockers are ineffective or contraindicated<nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
 |-
-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''Intravenous procainamide may be reasonable for acute treatment in pregnant patients with SV <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Intravenous [[procainamide]] may be reasonable for acute treatment in pregnant patients with SV <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
 |-
-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''Intravenous amiodarone may be considered for acute treatment in pregnant patients with potentially lifethreatening
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Intravenous [[amiodarone]] may be considered for acute treatment in pregnant patients with potentially lifethreatening SVT when other therapies are ineffective or contraindicated <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
-SVT when other therapies are ineffective or contraindicated <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
 |}
 ===Management of ongoing SVT in Pregnant Patients===
 {|class="wikitable" style="width:80%"
@@ Line 47: / Line 46: @@
 | colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''The following drugs, alone or in combination, can be effective for ongoing management in pregnant
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The following drugs, alone or in combination, can be effective for ongoing management in pregnant patients with highly symptomatic SVT:
-patients with highly symptomatic SVT:
+a. [[Digoxin]], b. [[Flecainide]], c. [[Metoprolol]], d. [[Propafenone]], e. [[Propranolol]], f. [[Sotalol]], g. [[Verapamil]]<nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
-a. Digoxin, b. Flecainide, c. Metoprolol, d. Propafenone, e. Propranolol, f. Sotalol, g. Verapamil<nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
 |}
@@ Line 56: / Line 54: @@
 | colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''Catheter ablation may be reasonable in pregnant patients with highly symptomatic, recurrent, drug-refractory SVT with efforts toward minimizing radiation exposure <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Catheter ablation]] may be reasonable in pregnant patients with highly symptomatic, recurrent, drug-refractory SVT with efforts toward minimizing radiation exposure <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
 |-
-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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 <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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 <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD]])'' <nowiki>"</nowiki>
 |}