ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias∗∗This document does not cover atrial fibrillation; atrial fibrillation is covered in the ACC/AHA/ESC guidelines on the management of patients with atrial fibrillation found on the ACC, AHA, and ESC Web sites.—executive summary

Blomström‐Lundqvist, Carina; Scheinman, Melvin M.; Antman, Elliott M.; Smith, Sidney C.

doi:10.1016/j.jacc.2003.08.013

Cited by 595 publications

(99 citation statements)

References 214 publications

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“…26,27 In women without structural heart disease, paroxysmal SVT is most commonly because of atrioventricular nodal reentrant tachycardia (AVNRT) followed by atrioventricular reciprocating tachycardia. 2 It is unclear whether pregnancy increases the risk of the first onset of SVT.…”

Section: Supraventricular Tachycardiamentioning

confidence: 99%

“…Verapamil is considered a third line agent. 27 For patients with frequent symptomatic episodes, metoprolol or verapamil can be used for prevention of SVT. Although digoxin is safe in pregnancy, it often is ineffective alone but has been used in combination with a β-blocker for AVNRT.…”

Section: Supraventricular Tachycardiamentioning

confidence: 99%

“…β-Blockers can be used cautiously in patients with Wolff-Parkinson-White syndrome, especially if the accessory pathway is not capable of rapid conduction. 27 Otherwise, class I AADs such as flecainide or quinidine may be used to slow conduction in the accessory pathway. Although catheter ablation is the treatment of choice for Wolff-Parkinson-White in the nonpregnant patient, this is best avoided if possible during pregnancy.…”

Section: Accessory Pathways and Wolff-parkinson-whitementioning

confidence: 99%

See 2 more Smart Citations

Contemporary Management of Arrhythmias During Pregnancy

Enriquez

Economy

Tedrow

2014

Circ: Arrhythmia and Electrophysiology

126

119

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Section: Supraventricular Tachycardiamentioning

confidence: 99%

Section: Supraventricular Tachycardiamentioning

confidence: 99%

Section: Accessory Pathways and Wolff-parkinson-whitementioning

confidence: 99%

See 1 more Smart Citation

Contemporary Management of Arrhythmias During Pregnancy

Enriquez

Economy

Tedrow

2014

Circ: Arrhythmia and Electrophysiology

126

119

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…”

mentioning

confidence: 99%

Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation

et al. 2014

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[1][2][3][4][5][6][7][8][9][10][11] Among a large series of WPW patients resuscitated from a sudden cardiac death, more than a half had ventricular fibrillation (VF) as the sentinel event, 4 which suggests that the risk of sudden death in the asymptomatic population is indeed underrecognized.9,10 The earliest alarming reports of sudden cardiac death were published in the late 1930s, 6,7 but the clinical manifestations typically range from an abnormal ECG finding without symptoms to cardiac arrest or sudden cardiac death. Anecdotal case series on the asymptomatic Background-The management of Wolff-Parkinson-White is based on the distinction between asymptomatic and symptomatic presentations, but evidence is limited in the asymptomatic population. Methods and Results-The Wolff-Parkinson-White registry was an 8-year prospective study of either symptomatic or asymptomatic Wolff-Parkinson-White patients referred to our Arrhythmology Department for evaluation or ablation. Inclusion criteria were a baseline electrophysiological testing with or without radiofrequency catheter ablation (RFA). Primary end points were the percentage of patients who experienced ventricular fibrillation (VF) or potentially malignant arrhythmias and risk factors. Among 2169 enrolled patients, 1001 (550 asymptomatic) did not undergo RFA (no-RFA group) and 1168 (206 asymptomatic) underwent ablation (RFA group). There were no differences in clinical and electrophysiological characteristics between the 2 groups except for symptoms. In the no-RFA group, VF occurred in 1.5% of patients, virtually exclusively (13 of 15) in children (median age, 11 years), and was associated with a short accessory pathway antegrade refractory period (P<0.001) and atrioventricular reentrant tachycardia initiating atrial fibrillation (P<0.001) but not symptoms. In the RFA group, ablation was successful in 98.5%, and after RFA, no patients developed malignant arrhythmias or VF over the 8-year follow-up. Untreated patients were more likely to experience malignant arrhythmias and VF (log-rank P<0.001). Time-dependent receiver-operating characteristic curves for predicting VF identified an optimal anterograde effective refractory period of the accessory pathway cutoff of 240 milliseconds. Conclusions-The prognosis of the Wolff-Parkinson-White syndrome essentially depends on intrinsic electrophysiological properties of AP rather than on symptoms. RFA performed during the same procedure after electrophysiological testing is of benefit in improving the long-term outcomes. (Circulation. 2014;130:811-819.)

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“…The rate of stroke, TIA, or systemic embolism in patients with CIED who underwent transseptal SVT ablation was 1.5 per 100 person‐years. These patients have typically been considered “low risk” for embolic events and guidelines currently do not recommend anticoagulation 20. Similarly, whereas OAC is recommended after VT ablation in patients with structural heart disease, current expert consensus is to not routinely anticoagulate those with a structurally normal heart 21.…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke or Systemic Embolism After Transseptal Ablation of Arrhythmias in Patients With Cardiac Implantable Electronic Devices

Madhavan

Yao

Sangaralingham

et al. 2016

JAHA

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BackgroundIncidental mobile thrombi are commonly found on endovascular leads of cardiac implantable electronic devices (CIEDs). Transseptal puncture for catheter ablation of arrhythmia poses a risk for paradoxical embolism. We examined risk of ischemic stroke, transient ischemic attack (TIA), or systemic embolism after transseptal ablation in patients with and without CIEDs.Methods and ResultsUsing a national administrative claims database, 31 720 patients who underwent a transseptal catheter ablation between January 2004 and September 2014 were identified. Two propensity‐matched cohorts were created by matching demographic variables, administrative variables, Charlson Comorbidity Index, CHA 2 DS 2‐Vasc score, and year and indication for ablation (5533 and 11 300 patients with and without CIEDs). Incidence rates and Cox proportional hazards models were used to estimate risk of ischemic stroke, TIA, or systemic embolism for patients with and without CIEDs. Impact of oral anticoagulation (OAC) use on the endpoint was examined. Over a mean follow‐up of 2.1 years, the incidence of the combined endpoint was 1.9 per 100 person‐years in patients with CIEDs and 1.5 per 100 person‐years in patients without CIEDs (P=0.03). Among patients not on OAC, presence of a cardiac device was associated with an increased risk (hazard ratio [HR], 1.71 [1.24–2.35]; P<0.01), whereas there was no association noted among patients treated with OAC (HR, 0.98 [0.75–1.28]).Conclusion CIEDs are associated with an increased risk of stroke, TIA, or systemic embolism after transseptal ablation, but this risk is attenuated with postablation OAC use. Role of anticoagulation post‐transseptal ablation in patients with CIED warrants further investigation.

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Cited by 595 publications

References 214 publications

Contemporary Management of Arrhythmias During Pregnancy

Contemporary Management of Arrhythmias During Pregnancy

Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation

Ischemic Stroke or Systemic Embolism After Transseptal Ablation of Arrhythmias in Patients With Cardiac Implantable Electronic Devices

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