2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

Page, Richard L.; Joglar, José A.; Caldwell, Mary A.; Calkins, Hugh; Conti, Jamie B.; Deal, Barbara J.; Estes, N.A. Mark; Field, Michael E.; Goldberger, Zachary D.; Hammill, Stephen C.; Indik, Julia H.; Lindsay, Bruce D.; Olshansky, Brian; Russo, Andrea M.; Shen, Win‐Kuang; Tracy, Cynthia M.; Al‐Khatib, Sana M.

doi:10.1016/j.jacc.2015.08.856

Cited by 338 publications

(135 citation statements)

References 523 publications

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“…SVA was defined as atrial fibrillation or any form of supraventricular tachycardia that originated within the tissue of His bundle or above [21]. Types encountered in Ebstein’s anomaly were as follows: focal atrial tachycardia (focal AT); macro-reentrant atrial tachycardia (reentrant AT), which included typical atrial flutter and intra-atrial reentrant tachycardia [22]; and atrial fibrillation (AF) [3, 21, 22]. Patients with a documented accessory pathway mediated tachycardia which included Wollf–Parkinson–White syndrome were not further analyzed since the substrate for this arrhythmia is proved not to be associated with the regions of fibrosis [21].…”

Section: Methodsmentioning

confidence: 99%

Clinical aspects of myocardial fibrosis in adults with Ebstein’s anomaly

et al. 2018

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Heart failure and arrhythmia are common complications in adults with Ebstein’s anomaly. They may result not only from hemodynamic alterations, but also from myocardial fibrosis. Late gadolinium enhancement (LGE) by CMR enables the evaluation of myocardial fibrosis. The aim of the study was to asses the presence of LGE and its relation to clinical outcome. We studied a group of 37 unoperated adults aged 43.0 ± 14.4 years with Ebstein’s anomaly from the congenital heart disease outpatient clinic. Study protocol included: cardiopulmonary test, assessment of supraventricular arrhythmia (SVA), and CMR with evaluation of cardiac chambers’ morphology and function, and presence of LGE. Variables following normal distribution were shown as mean ± SD if otherwise median (range) was applied. Fibrosis was found in 18 patients (48.6%) and was distributed as follows: 12 patients (32.4%) in the right atrium, 12 (32.4%) in the atrialized right ventricle, and 2 (5.4%) in the functional right ventricle. In patients with fibrosis, the tricuspid regurgitation fraction was bigger (48.3 ± 19.7 vs. 36.1 ± 22.6%, p = 0.048) and SVA was more frequent [12 (66.7%) vs. 6 (31.6%), p = 0.046] when compared to patients without fibrosis. However, exercise capacity did not differ between patients with and without LGE (peak VO2 24.0 ± 4.7 vs. 23.7 ± 4.4, p = 0.87). In adults with Ebstein’s anomaly fibrosis estimated by LGE-CMR was localized in the right atrium and the right ventricle only. Volume overload resulting from tricuspid regurgitation might be a factor conducive to fibrosis. Myocardial fibrosis did not influence exercise capacity. Association between myocardial fibrosis and supraventricular arrhythmia was confirmed.

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Section: Methodsmentioning

confidence: 99%

Clinical aspects of myocardial fibrosis in adults with Ebstein’s anomaly

et al. 2018

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“…The drugs used for rate control in atrial fibrillation and atrial flutter are mainly beta blockers (class II), non-dihydropyridine calcium channel blockers (class IV), and digoxin (class V) [16, 22]. All three types of drugs work by lowering the heart rate which might consequently prevent excessive tachycardia and limit symptoms.…”

Section: Description Of the Interventionsmentioning

confidence: 99%

The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis

et al. 2017

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BackgroundAtrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2% in the western world. Atrial flutter, another arrhythmia, occurs less often with an incidence of approximately 200,000 new patients per year in the USA. Patients with atrial fibrillation and atrial flutter have an increased risk of death and morbidities. The management of atrial fibrillation and atrial flutter is often based on interventions aiming at either a rhythm control strategy or a rate control strategy. The evidence on the comparable effects of these strategies is unclear. This protocol for a systematic review aims at identifying the best overall treatment strategy for atrial fibrillation and atrial flutter.MethodsThis protocol for a systematic review was performed following the recommendations of the Cochrane Collaboration and the eight-step assessment procedure suggested by Jakobsen and colleagues. We plan to include all relevant randomised clinical trials assessing the effects of any rhythm control strategy versus any rate control strategy. We plan to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, Science Citation Index Expanded on Web of Science, and BIOSIS to identify relevant trials. Any eligible trial will be assessed and classified as either high risk of bias or low risk of bias, and our conclusions will be based on trials with low risk of bias. The analyses of the extracted data will be performed using Review Manager 5 and Trial Sequential Analysis. For both our primary and secondary outcomes, we will create a ‘Summary of Findings’ table and use GRADE assessment to assess the quality of the evidence.DiscussionThe results of this systematic review have the potential to benefit thousands of patients worldwide as well as healthcare systems and healthcare economy.Systematic review registrationPROSPERO CRD42016051433 Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0449-z) contains supplementary material, which is available to authorized users.

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“…Atrial flutter may be diagnosed using an electrocardiogram as characteristic flutter waves (F-waves) at a regular atrial rate of 250 to 350 beats per minute. The flutter waves may resemble P-waves or have a ‘saw-tooth’ shape [22]. …”

Section: Definition and Classificationmentioning

confidence: 99%

“…An intervention to control the heart rate, mainly digoxin, beta blockers, non-dihydropyridine calcium channel blockers, amiodarone, or sotalol, is therefore often necessary to reduce the heart rate and consequently prevent excessive tachycardia and limit symptoms in nearly all patients with atrial fibrillation and atrial flutter [16, 22]. Lowering the heart rate might also theoretically prevent the development of heart failure and tachycardia-mediated cardiomyopathy [18, 20, 37].…”

Section: Description Of the Interventionmentioning

confidence: 99%

Digoxin versus placebo, no intervention, or other medical interventions for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis

et al. 2017

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BackgroundAtrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2% in the western world. Atrial flutter, another arrhythmia, occurs less often with an incidence of approximately 200,000 new patients per year in the USA. Patients with atrial fibrillation and atrial flutter have an increased risk of death and morbidities. In the management of atrial fibrillation and atrial flutter, it is often necessary to use medical interventions to lower the heart rate. Lowering the heart rate may theoretically prevent the development of heart failure and tachycardia-mediated cardiomyopathy. The evidence on the benefits and harms of digoxin compared with placebo or with other medical interventions is unclear. This protocol for a systematic review aims at identifying the beneficial and harmful effects of digoxin compared with placebo, no intervention, or with other medical interventions for atrial fibrillation and atrial flutter.MethodsThis protocol for a systematic review was conducted following the recommendations of Cochrane and the eight-step assessment procedure suggested by Jakobsen and colleagues. We plan to include all relevant randomised clinical trials comparing digoxin with placebo, no intervention, or with other medical interventions. We plan to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, Science Citation Index Expanded on Web of Science, and BIOSIS to identify relevant trials. Any eligible trial will be assessed and classified as either at high risk of bias or low risk of bias, and our primary conclusions will be based on trials with low risk of bias. We will perform our meta-analyses of the extracted data using Review Manager 5.3 and Trial Sequential Analysis ver. 0.9.5.5 beta. For both our primary and secondary outcomes, we will create a ‘Summary of Findings’ table based on GRADE assessments of the quality of the evidence.DiscussionThe results of this systematic review have the potential to benefit millions of patients worldwide as well as healthcare economy.Systematic review registrationPROSPERO CRD42016052935Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0470-2) contains supplementary material, which is available to authorized users.

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2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

Cited by 338 publications

References 523 publications

Clinical aspects of myocardial fibrosis in adults with Ebstein’s anomaly

Clinical aspects of myocardial fibrosis in adults with Ebstein’s anomaly

The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis

Digoxin versus placebo, no intervention, or other medical interventions for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis

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