2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: Executive summary
2015; Elsevier BV; Volume: 13; Issue: 4 Linguagem: Inglês
10.1016/j.hrthm.2015.09.018
ISSN1556-3871
AutoresRichard L. Page, José A. Joglar, Mary A. Caldwell, Hugh Calkins, Jamie B. Conti, Barbara J. Deal, N.A. Mark Estes, Michael E. Field, Zachary D. Goldberger, Stephen C. Hammill, Julia H. Indik, Bruce D. Lindsay, Brian Olshansky, Andrea M. Russo, Win-Kuang Shen, Cynthia M. Tracy, Sana M. Al‐Khatib,
Tópico(s)Atrial Fibrillation Management and Outcomes
ResumoJonathan L. Halperin, MD, FACC, FAHA, Chair Glenn N. Levine, MD, FACC, FAHA, Chair-Elect Jeffrey L. Anderson, MD, FACC, FAHA, Immediate Past Chair ¶Former Task Force member; current member during this writing effort. Nancy M. Albert, PhD, RN, FAHA ¶Former Task Force member; current member during this writing effort. Sana M. Al-Khatib, MD, MHS, FACC, FAHA Kim K. Birtcher, PharmD, AACC Biykem Bozkurt, MD, PhD, FACC, FAHA Ralph G. Brindis, MD, MPH, MACC Joaquin E. Cigarroa, MD, FACC Lesley H. Curtis, PhD, FAHA Lee A. Fleisher, MD, FACC, FAHA Federico Gentile, MD, FACC Samuel Gidding, MD, FAHA Mark A. Hlatky, MD, FACC John Ikonomidis, MD, PhD, FAHA Jose Joglar, MD, FACC, FAHA Richard J. Kovacs, MD, FACC, FAHA ¶Former Task Force member; current member during this writing effort. E. Magnus Ohman, MD, FACC ¶Former Task Force member; current member during this writing effort. Susan J. Pressler, PhD, RN, FAHA Frank W. Sellke, MD, FACC, FAHA ¶Former Task Force member; current member during this writing effort. Win-Kuang Shen, MD, FACC, FAHA ¶Former Task Force member; current member during this writing effort. Duminda N. Wijeysundera, MD, PhD Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality cardiovascular care. In response to reports from the Institute of Medicine1Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Institute of Medicine (U.S.)Clinical Practice Guidelines We Can Trust. National Academies Press, Washington, DC2011Google Scholar, 2Committee on Standards for Systematic Reviews of Comparative Effectiveness Research, Institute of Medicine (U.S.)Finding What Works in Health Care: Standards for Systematic Reviews. National Academies Press, Washington, DC2011Google Scholar and a mandate to evaluate new knowledge and maintain relevance at the point of care, the ACC/AHA Task Force on Clinical Practice Guidelines (Task Force) modified its methodology.3ACCF/AHA Task Force on Practice Guidelines. Methodology Manual and Policies From the ACCF/AHA Task Force on Practice Guidelines. American College of Cardiology and American Heart Association. 2010. Available at: http://assets.cardiosource.com/Methodology_Manual_for_ACC_AHA_Writing_Committees.pdf and http://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/documents/downloadable/ucm_319826.pdf. Accessed January 23, 2015.Google Scholar, 4Jacobs A.K. Kushner F.G. Ettinger S.M. et al.ACCF/AHA clinical practice guideline methodology summit report: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; 61: 213-265Abstract Full Text Full Text PDF PubMed Google Scholar, 5Jacobs A.K. Anderson J.L. Halperin J.L. The evolution and future of ACC/AHA clinical practice guidelines: a 30-year journey: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 64: 1373-1384Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar The relationships between guidelines, data standards, appropriate use criteria, and performance measures are addressed elsewhere.4Jacobs A.K. Kushner F.G. Ettinger S.M. et al.ACCF/AHA clinical practice guideline methodology summit report: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; 61: 213-265Abstract Full Text Full Text PDF PubMed Google Scholar Practice guidelines provide recommendations applicable to patients with or at risk of developing cardiovascular disease. The focus is on medical practice in the United States, but guidelines developed in collaboration with other organizations may have a broader target. Although guidelines may inform regulatory or payer decisions, they are intended to improve quality of care in the interest of patients. Guideline Writing Committee (GWC) members review the literature; weigh the quality of evidence for or against particular tests, treatments, or procedures; and estimate expected health outcomes. In developing recommendations, the GWC uses evidence-based methodologies that are based on all available data.4Jacobs A.K. Kushner F.G. Ettinger S.M. et al.ACCF/AHA clinical practice guideline methodology summit report: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; 61: 213-265Abstract Full Text Full Text PDF PubMed Google Scholar, 5Jacobs A.K. Anderson J.L. Halperin J.L. The evolution and future of ACC/AHA clinical practice guidelines: a 30-year journey: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 64: 1373-1384Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar, 6Anderson J.L. Heidenreich P.A. Barnett P.G. et al.ACC/AHA statement on cost/value methodology in clinical practice guidelines and performance measures: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 63: 2304-2322Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Literature searches focus on randomized controlled trials (RCTs) but also include registries, nonrandomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion. Only selected references are cited. The Task Force recognizes the need for objective, independent Evidence Review Committees (ERCs) that include methodologists, epidemiologists, clinicians, and biostatisticians who systematically survey, abstract, and assess the evidence to address key clinical questions posed in the PICOTS format (P=population, I=intervention, C=comparator, O=outcome, T=timing, S=setting).4Jacobs A.K. Kushner F.G. Ettinger S.M. et al.ACCF/AHA clinical practice guideline methodology summit report: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; 61: 213-265Abstract Full Text Full Text PDF PubMed Google Scholar, 5Jacobs A.K. Anderson J.L. Halperin J.L. The evolution and future of ACC/AHA clinical practice guidelines: a 30-year journey: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 64: 1373-1384Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Practical considerations, including time and resource constraints, limit the ERCs to evidence that is relevant to key clinical questions and lends itself to systematic review and analysis that could affect the strength of corresponding recommendations. Recommendations developed by the GWC on the basis of the systematic review are marked “SR”. The term “guideline-directed medical therapy” refers to care defined mainly by ACC/AHA Class I recommendations. For these and all recommended drug treatment regimens, the reader should confirm dosage with product insert material and carefully evaluate for contraindications and interactions. Recommendations are limited to treatments, drugs, and devices approved for clinical use in the United States. The Class of Recommendation (COR; i.e., the strength of the recommendation) encompasses the anticipated magnitude and certainty of benefit in proportion to risk. The Level of Evidence (LOE) rates evidence supporting the effect of the intervention on the basis of the type, quality, quantity, and consistency of data from clinical trials and other reports (Table 1. )5Jacobs A.K. Anderson J.L. Halperin J.L. The evolution and future of ACC/AHA clinical practice guidelines: a 30-year journey: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 64: 1373-1384Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar, 7Halperin J.L. Levine G.N. Al-Khatib S.M. Further evolution of the ACC/AHA clinical practice guideline recommendation classification system: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol. 2015; (In press. http://dx.doi.org/10.1016/j.jacc.2015.09.001)Google Scholar Unless otherwise stated, recommendations are sequenced by COR and then by LOE. Where comparative data exist, preferred strategies take precedence. When >1 drug, strategy, or therapy exists within the same COR and LOE and no comparative data are available, options are listed alphabetically. Each recommendation is followed by supplemental text linked to supporting references and evidence tables.Table 1Applying class of recommendation and level of evidence to clinical strategies, interventions, treatments, or diagnostic testing in patient care* Open table in a new tab The ACC and AHA sponsor the guidelines without commercial support, and members volunteer their time. The Task Force zealously avoids actual, potential, or perceived conflicts of interest that might arise through relationships with industry or other entities (RWI). All GWC members and reviewers are required to disclose current industry relationships or personal interests from 12 months before initiation of the writing effort. Management of RWI involves selecting a balanced GWC and assuring that the chair and a majority of committee members have no relevant RWI (Appendix 1). Members are restricted with regard to writing or voting on sections to which their RWI apply. For transparency, members’ comprehensive disclosure information is available online. Comprehensive disclosure information for the Task Force is also available online. The Task Force strives to avoid bias by selecting experts from a broad array of backgrounds representing different geographic regions, sexes, ethnicities, intellectual perspectives/biases, and scopes of clinical practice, and by inviting organizations and professional societies with related interests and expertise to participate as partners or collaborators. Managing patients with multiple conditions can be complex, especially when recommendations applicable to coexisting illnesses are discordant or interacting.8Arnett D.K. Goodman R.A. Halperin J.L. et al.AHA/ACC/HHS strategies to enhance application of clinical practice guidelines in patients with cardiovascular disease and comorbid conditions: from the American Heart Association, American College of Cardiology, and U.S. Department of Health and Human Services.J Am Coll Cardiol. 2014; 64: 1851-1856Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar The guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances. The recommendations should not replace clinical judgment. Management in accordance with guideline recommendations is effective only when followed. Adherence to recommendations can be enhanced by shared decision making between clinicians and patients, with patient engagement in selecting interventions based on individual values, preferences, and associated conditions and comorbidities. Consequently, circumstances may arise in which deviations from these guidelines are appropriate. The recommendations in this guideline represent the official policy of the ACC and AHA until superseded by published addenda, statements of clarification, focused updates, or revised full-text guidelines. To ensure that guidelines remain current, new data are reviewed biannually to determine whether recommendations should be modified. In general, full revisions are posted in 5-year cycles.3ACCF/AHA Task Force on Practice Guidelines. Methodology Manual and Policies From the ACCF/AHA Task Force on Practice Guidelines. American College of Cardiology and American Heart Association. 2010. Available at: http://assets.cardiosource.com/Methodology_Manual_for_ACC_AHA_Writing_Committees.pdf and http://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/documents/downloadable/ucm_319826.pdf. Accessed January 23, 2015.Google Scholar, 5Jacobs A.K. Anderson J.L. Halperin J.L. The evolution and future of ACC/AHA clinical practice guidelines: a 30-year journey: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 64: 1373-1384Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar The reader is encouraged to consult the full-text guideline9Page R.L. Joglar J.A. Al-Khatib S.M. et al.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. 2015; (In press. http://dx.doi.org/10.1016/j.jacc.2015.09.019)Google Scholar for additional guidance and details with regard to SVT because the executive summary contains limited information. Jonathan L. Halperin, MD, FACC, FAHA Chair, ACC/AHA Task Force on Clinical Practice Guidelines The recommendations listed in this guideline are, whenever possible, evidence based. An extensive evidence review was conducted in April 2014 that included literature published through September 2014. Other selected references published through May 2015 were incorporated by the GWC. Literature included was derived from research involving human subjects, published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. The relevant search terms and data are included in evidence tables in the Online Data Supplement. Additionally, the GWC reviewed documents related to supraventricular tachycardia (SVT) previously published by the ACC, AHA, and Heart Rhythm Society (HRS). References selected and published in this document are representative and not all-inclusive. An independent ERC was commissioned to perform a systematic review of key clinical questions, the results of which were considered by the GWC for incorporation into this guideline. The systematic review report on the management of asymptomatic patients with Wolff-Parkinson-White (WPW) syndrome is published in conjunction with this guideline.10Al-Khatib S.M. Arshad A. Balk E.M. et al.Risk stratification for arrhythmic events in patients with asymptomatic pre-excitation: a systematic review for the 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. 2015; (In press. http://dx.doi.org/10.1016/j.jacc.2015.09.018)Google Scholar The GWC consisted of clinicians, cardiologists, electrophysiologists (including those specialized in pediatrics), and a nurse (in the role of patient representative) and included representatives from the ACC, AHA, and HRS. This document was reviewed by 8 official reviewers nominated by the ACC, AHA, and HRS, and 25 individual content reviewers. Reviewers’ RWI information was distributed to the GWC and is published in this document (Appendix 2). This document was approved for publication by the governing bodies of the ACC, the AHA, and the HRS. The purpose of this joint ACC/AHA/HRS document is to provide a contemporary guideline for the management of adults with all types of SVT other than atrial fibrillation (AF). Although AF is, strictly speaking, an SVT, the term SVT generally does not refer to AF. AF is addressed in the 2014 ACC/AHA/HRS Guideline for the Management of Atrial Fibrillation (2014 AF guideline).11January C.T. Wann L.S. Alpert J.S. et al.2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.J Am Coll Cardiol. 2014; 64: 2246-2280Abstract Full Text Full Text PDF Scopus (0) Google Scholar The present guideline addresses other SVTs, including regular narrow–QRS complex tachycardias, as well as other, irregular SVTs (e.g., atrial flutter with irregular ventricular response and multifocal atrial tachycardia [MAT]). This guideline supersedes the “2003 ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias”.12Blomström-Lundqvist C. Scheinman M.M. Aliot E.M. et al.ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias–executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Developed in collaboration with NASPE-Heart Rhythm Society.J Am Coll Cardiol. 2003; 42: 1493-1531Abstract Full Text Full Text PDF PubMed Scopus (360) Google Scholar Although this document is aimed at the adult population (≥18 years of age) and offers no specific recommendations for pediatric patients, as per the reference list, we examined literature that included pediatric patients. In some cases, the data from noninfant pediatric patients helped inform this guideline. For the purposes of this guideline, SVT is defined as per Table 2, which provides definitions and the mechanism(s) of each type of SVT. The term SVT does not generally include AF, and this document does not discuss the management of AF.Table 2Relevant Terms and DefinitionsArrhythmia/TermDefinitionSupraventricular tachycardia (SVT)An umbrella term used to describe tachycardias (atrial and/or ventricular rates in excess of 100 bpm at rest), the mechanism of which involves tissue from the His bundle or above. These SVTs include inappropriate sinus tachycardia, AT (including focal and multifocal AT), macroreentrant AT (including typical atrial flutter), junctional tachycardia, AVNRT, and various forms of accessory pathway-mediated reentrant tachycardias. In this guideline, the term does not include AF.Paroxysmal supraventricular tachycardia (PSVT)A clinical syndrome characterized by the presence of a regular and rapid tachycardia of abrupt onset and termination. These features are characteristic of AVNRT or AVRT, and, less frequently, AT. PSVT represents a subset of SVT.Atrial fibrillation (AF)A supraventricular arrhythmia with uncoordinated atrial activation and, consequently, ineffective atrial contraction. ECG characteristics include: 1) irregular atrial activity, 2) absence of distinct P waves, and 3) irregular R-R intervals (when atrioventricular conduction is present). AF is not addressed in this document.Sinus tachycardiaRhythm arising from the sinus node in which the rate of impulses exceeds 100 bpm.•Physiologic sinus tachycardiaAppropriate increased sinus rate in response to exercise and other situations that increase sympathetic tone.•Inappropriate sinus tachycardiaSinus heart rate >100 bpm at rest, with a mean 24-h heart rate >90 bpm not due to appropriate physiological responses or primary causes such as hyperthyroidism or anemia.Atrial tachycardia (AT)•Focal ATAn SVT arising from a localized atrial site, characterized by regular, organized atrial activity with discrete P waves and typically an isoelectric segment between P waves. At times, irregularity is seen, especially at onset (“warm-up”) and termination (“warm-down”). Atrial mapping reveals a focal point of origin.•Sinus node reentry tachycardiaA specific type of focal AT that is due to microreentry arising from the sinus node complex, characterized by abrupt onset and termination, resulting in a P-wave morphology that is indistinguishable from sinus rhythm.•Multifocal atrial tachycardia (MAT)An irregular SVT characterized by ≥3 distinct P-wave morphologies and/or patterns of atrial activation at different rates. The rhythm is always irregular.Atrial flutter•Cavotricuspid isthmus–dependent atrial flutter: typicalMacroreentrant AT propagating around the tricuspid annulus, proceeding superiorly along the atrial septum, inferiorly along the right atrial wall, and through the cavotricuspid isthmus between the tricuspid valve annulus and the Eustachian valve and ridge. This activation sequence produces predominantly negative “sawtooth” flutter waves on the ECG in leads 2, 3, and aVF and a late positive deflection in V1. The atrial rate can be slower than the typical 300 bpm (cycle length 200 ms) in the presence of antiarrhythmic drugs or scarring. It is also known as “typical atrial flutter” or “cavotricuspid isthmus–dependent atrial flutter” or “counterclockwise atrial flutter.”•Cavotricuspid isthmus– dependent atrial flutter: reverse typicalMacroreentrant AT that propagates around in the direction reverse that of typical atrial flutter. Flutter waves typically appear positive in the inferior leads and negative in V1. This type of atrial flutter is also referred to as “reverse typical” atrial flutter or “clockwise typical atrial flutter.”•Atypical or non–cavotricuspid isthmus–dependent atrial flutterMacroreentrant ATs that do not involve the cavotricuspid isthmus. A variety of reentrant circuits may include reentry around the mitral valve annulus or scar tissue within the left or right atrium. A variety of terms have been applied to these arrhythmias according to the reentry circuit location, including particular forms, such as “LA flutter” and “LA macroreentrant tachycardia” or incisional atrial reentrant tachycardia due to reentry around surgical scars.Junctional tachycardiaA nonreentrant SVT that arises from the AV junction (including the His bundle).Atrioventricular nodal reentrant tachycardia (AVNRT)A reentrant tachycardia involving 2 functionally distinct pathways, generally referred to as “fast” and “slow” pathways. Most commonly, the fast pathway is located near the apex of Koch’s triangle, and the slow pathway inferoposterior to the compact AV node tissue. Variant pathways have been described, allowing for “slow-slow” AVNRT.•Typical AVNRTAVNRT in which a slow pathway serves as the anterograde limb of the circuit and the fast pathway serves as the retrograde limb (also called “slow-fast AVNRT”).•Atypical AVNRTAVNRT in which the fast pathway serves as the anterograde limb of the circuit and a slow pathway serves as the retrograde limb (also called “fast-slow AV node reentry”) or a slow pathway serves as the anterograde limb and a second slow pathway serves as the retrograde limb (also called “slow-slow AVNRT”).Accessory pathwayFor the purpose of this guideline, an accessory pathway is defined as an extranodal AV pathway that connects the myocardium of the atrium to the ventricle across the AV groove. Accessory pathways can be classified by their location, type of conduction (decremental or nondecremental), and whether they are capable of conducting anterogradely, retrogradely, or in both directions. Of note, accessory pathways of other types (such as atriofascicular, nodo-fascicular, nodo-ventricular, and fasciculoventricular pathways) are uncommon and are discussed only briefly in this document (Section 7).•Manifest accessory pathwaysA pathway that conducts anterogradely to cause ventricular pre-excitation pattern on the ECG.•Concealed accessory pathwayA pathway that conducts only retrogradely and does not affect the ECG pattern during sinus rhythm.•Pre-excitation patternAn ECG pattern reflecting the presence of a manifest accessory pathway connecting the atrium to the ventricle. Pre-excited ventricular activation over the accessory pathway competes with the anterograde conduction over the AV node and spreads from the accessory pathway insertion point in the ventricular myocardium. Depending on the relative contribution from ventricular activation by the normal AV nodal/His Purkinje system versus the manifest accessory pathway, a variable degree of pre-excitation, with its characteristic pattern of a short P-R interval with slurring of the initial upstroke of the QRS complex (delta wave), is observed. Pre-excitation can be intermittent or not easily appreciated for some pathways capable of anterograde conduction; this is usually associated with a low-risk pathway, but exceptions occur.•Asymptomatic pre-excitation (isolated pre-excitation)The abnormal pre-excitation ECG pattern in the absence of documented SVT or symptoms consistent with SVT.•Wolff-Parkinson-White (WPW) syndromeSyndrome characterized by documented SVT or symptoms consistent with SVT in a patient with ventricular pre-excitation during sinus rhythm.Atrioventricular reentrant tachycardia (AVRT)A reentrant tachycardia, the electrical pathway of which requires an accessory pathway, the atrium, atrioventricular node (or second accessory pathway), and ventricle.•Orthodromic AVRTAn AVRT in which the reentrant impulse uses the accessory pathway in the retrograde direction from the ventricle to the atrium, and the AV node in the anterograde direction. The QRS complex is generally narrow or may be wide because of pre-existing bundle-branch block or aberrant conduction.•Antidromic AVRTAn AVRT in which the reentrant impulse uses the accessory pathway in the anterograde direction from the atrium to the ventricle, and the AV node for the retrograde direction. Occasionally, instead of the AV node, another accessory pathway can be used in the retrograde direction, which is referred to as pre-excited AVRT. The QRS complex is wide (maximally pre-excited).Permanent form of junctional reciprocating tachycardia (PJRT)A rare form of nearly incessant orthodromic AVRT involving a slowly conducting, concealed, usually posteroseptal accessory pathway.Pre-excited AFAF with ventricular pre-excitation caused by conduction over ≥1 accessory pathway(s).AF indicates atrial fibrillation; AT, atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; bpm, beats per minute; ECG, electrocardiogram/electrocardiographic; LA, left atrial; MAT, multifocal atrial tachycardia; PJRT, permanent form of junctional reciprocating tachycardia; PSVT, paroxysmal supraventricular tachycardia; SVT, supraventricular tachycardia; and WPW, Wolff-Parkinson-White. Open table in a new tab AF indicates atrial fibrillation; AT, atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; bpm, beats per minute; ECG, electrocardiogram/electrocardiographic; LA, left atrial; MAT, multifocal atrial tachycardia; PJRT, permanent form of junctional reciprocating tachycardia; PSVT, paroxysmal supraventricular tachycardia; SVT, supraventricular tachycardia; and WPW, Wolff-Parkinson-White. The best available evidence indicates that the prevalence of SVT in the general population is 2.29 per 1,000 persons.13Orejarena L.A. Vidaillet H. DeStefano F. et al.Paroxysmal supraventricular tachycardia in the general population.J Am Coll Cardiol. 1998; 31: 150-157Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar When adjusted by age and sex in the U.S. population, the incidence of paroxysmal supraventricular tachycardia (PSVT) is estimated to be 36 per 100,000 persons per year.13Orejarena L.A. Vidaillet H. DeStefano F. et al.Paroxysmal supraventricular tachycardia in the general population.J Am Coll Cardiol. 1998; 31: 150-157Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar There are approximately 89,000 new cases per year and 570,000 persons with PSVT.13Orejarena L.A. Vidaillet H. DeStefano F. et al.Paroxysmal supraventricular tachycardia in the general population.J Am Coll Cardiol. 1998; 31: 150-157Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar Compared with patients with cardiovascular disease, those with PSVT without any cardiovascular disease are younger (37 versus 69 years; p = 0.0002) and have faster PSVT (186 versus 155 bpm; p = 0.0006). Women have twice the risk of men of developing PSVT.13Orejarena L.A. Vidaillet H. DeStefano F. et al.Paroxysmal supraventricular tachycardia in the general population.J Am Coll Cardiol. 1998; 31: 150-157Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar Individuals >65 years of age have >5 times the risk of younger persons of developing PSVT.13Orejarena L.A. Vidaillet H. DeStefano F. et al.Paroxysmal supraventricular tachycardia in the general population.J Am Coll Cardiol. 1998; 31: 150-157Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar Atrioventricular nodal reentrant tachycardia (AVNRT) is more common in persons who are middle-aged or older, whereas in adolescents the prevalence may be more balanced between atrioventricular reentrant tachycardia (AVRT) and AVNRT, or AVRT may be more prevalent.13Orejarena L.A. Vidaillet H. DeStefano F. et al.Paroxysmal supraventricular tachycardia in the general population.J Am Coll Cardiol. 1998; 31: 150-157Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar The relative frequency of tachycardia mediated by an accessory pathway decreases with age. The incidence of manifest pre-excitation or WPW pattern on electrocardiogram/electrocardiographic (ECG) tracings in the general population is 0.1% to 0.3%. However, not all patients with manifest ventricular pre-excitation develop PSVT.14Lu C.-W. Wu M.-H. Chen H.-C. et al.Epidemiological profil
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