The 2019 ESC Guidelines for the Management of Patients with Supraventricular Tachycardia

of the Guideline Writing GroupDr Demos Katritsis and his writing group have produced an important new guidelines document on the management of all types of supraventricular tachycardias (SVTs).The one exception is atrial fibrillation (AF), which is covered in the 2016 European Society of Cardiology (ESC) AF guidelines.This document is a complete rewrite of the 2003 SVT guidelines, which were published as a joint document with the American Heart Association and the American College of Cardiology.In this brief article, I will highlight the most important features of the new 2019 ESC SVT Guidelines.The first important change in the 2019 ESC SVT guideline, when compared with the prior guideline published 16 years earlier is that the Class and level of recommendations supporting catheter ablation for chronic treatment of all types of SVTs have been increased.This shift reflects the vast literature, and large and consistent worldwide experience supporting the curative role of catheter ablation for most types of SVT.Catheter ablation is now provided with a Class 1 level of evidence (LOE) A or B recommendation for nearly all SVTs.The most notable exceptions to this rule are inappropriate sinus tachycardia and multifocal atrial tachycardia, for which catheter ablation plays little to no role in management.Another exception is SVTs in patients with congenital heart disease, where catheter ablation in experienced centres is provided a 2A, LOE C recommendation.Another important change reflects the role of pharmacologic therapy in SVT management.The document has downgraded the Class and LOE of recommendations for pharmacologic therapy of most types of SVTs.This shift reflects the remarkable paucity of data from clinical trials demonstrating the safety and efficacy of most antiarrhythmic agents, including beta-blockers, calcium channel blockers, digoxin, and also Class 1 and 3 antiarrhythmic agents.Oral disopyramide, procainamide, quinidine, and sotalol are not included in the document.The only recognized role of amiodarone is for acute management of wide complex tachycardia (Class 2b, LOE B), focal atrial tachycardia (Class 2b, LOE C), macro-reentrant atrial arrhythmias (Class 2b, LOE C), and antidromic atrioventricular reentrant tachycardia (Class 2b, LOE B).And the only recognized role for