Supraventricular tachycardia AHA recommendations for Management of Asymptomatic Patients With Pre-Excitation: Difference between revisions
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==Overview== | ==Overview== | ||
In asymptomatic patients with pre-excitation, the findings of abrupt loss of conduction over a manifest pathway during exercise testing in sinus rhythm or intermittent loss of pre-excitation during ECG or ambulatory monitoring are useful to identify patients at low risk of rapid conduction over the pathway. An [[EP study]] is reasonable in asymptomatic patients with pre-excitation to risk-stratify for arrhythmic events. Catheter ablation of the accessory pathway is reasonable in asymptomatic patients with pre-excitation if an EP study identifies a high risk of arrhythmic events, including rapidly conducting pre-excited AF.<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 Asymptomatic Patients With Pre-Excitation== | ==Management of Asymptomatic Patients With Pre-Excitation== | ||
2015 AHA recommendations for the management of asymptomatic patients with pre-excitation 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> | 2015 AHA recommendations for the management of asymptomatic patients with [[pre-excitation]] 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> | ||
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|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''In asymptomatic patients with pre-excitation, the findings of abrupt loss of conduction over a manifest pathway during exercise testing in sinus rhythm <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B_R ]])'' <nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In asymptomatic patients with pre-excitation, the findings of abrupt loss of conduction over a manifest pathway during exercise testing in sinus rhythm <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B_R ]])'' <nowiki>"</nowiki> or intermittent loss of pre-excitation during ECG or ambulatory monitoring ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C-LD ]])'' <nowiki>"</nowiki> are useful to identify patients at low risk of rapid conduction over the pathway. | ||
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|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' An EP study is reasonable in asymptomatic patients with pre-excitation to risk-stratify for arrhythmic events<nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR ]])'' <nowiki>"</nowiki> | | bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' An [[EP study]] is reasonable in asymptomatic patients with pre-excitation to risk-stratify for arrhythmic events<nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR ]])'' <nowiki>"</nowiki> | ||
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Catheter ablation of the accessory pathway is reasonable in asymptomatic patients if the presence of pre-excitation precludes specific employment (such as with pilots) <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B-NR ]])'' <nowiki>"</nowiki> | | bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' [[Catheter ablation]] of the accessory pathway is reasonable in asymptomatic patients if the presence of pre-excitation precludes specific employment (such as with pilots) <nowiki>"</nowiki>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B-NR ]])'' <nowiki>"</nowiki> | ||
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Latest revision as of 16:27, 27 October 2016
Supraventricular tachycardia Microchapters |
Differentiating Among the Different Types of Supraventricular Tachycardia |
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Differentiating Supraventricular Tachycardia from Ventricular Tachycardia |
Diagnosis |
Treatment |
2015 ACC/AHA Guideline Recommendations |
Case Studies |
Supraventricular tachycardia AHA recommendations for Management of Asymptomatic Patients With Pre-Excitation On the Web |
American Roentgen Ray Society Images of Supraventricular tachycardia AHA recommendations for Management of Asymptomatic Patients With Pre-Excitation |
Directions to Hospitals Treating Supraventricular tachycardia |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
In asymptomatic patients with pre-excitation, the findings of abrupt loss of conduction over a manifest pathway during exercise testing in sinus rhythm or intermittent loss of pre-excitation during ECG or ambulatory monitoring are useful to identify patients at low risk of rapid conduction over the pathway. An EP study is reasonable in asymptomatic patients with pre-excitation to risk-stratify for arrhythmic events. Catheter ablation of the accessory pathway is reasonable in asymptomatic patients with pre-excitation if an EP study identifies a high risk of arrhythmic events, including rapidly conducting pre-excited AF.[1]
Management of Asymptomatic Patients With Pre-Excitation
2015 AHA recommendations for the management of asymptomatic patients with pre-excitation are described below:[1]
Class I |
"1. In asymptomatic patients with pre-excitation, the findings of abrupt loss of conduction over a manifest pathway during exercise testing in sinus rhythm "(Level of Evidence: B_R ) " or intermittent loss of pre-excitation during ECG or ambulatory monitoring (Level of Evidence:C-LD ) " are useful to identify patients at low risk of rapid conduction over the pathway. |
Class IIa |
"1. An EP study is reasonable in asymptomatic patients with pre-excitation to risk-stratify for arrhythmic events"(Level of Evidence: B-NR ) " |
"2. Catheter ablation of the accessory pathway is reasonable in asymptomatic patients with pre-excitation if an EP study identifies a high risk of arrhythmic events, including rapidly conducting pre-excited AF ("(Level of Evidence:B-NR ) " |
"3. Catheter ablation of the accessory pathway is reasonable in asymptomatic patients if the presence of pre-excitation precludes specific employment (such as with pilots) "(Level of Evidence:B-NR ) " |
"4. Observation, without further evaluation or treatment, is reasonable in asymptomatic patients with pre-excitation "(Level of Evidence:B-NR ) " |
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.