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2019

ESC 2019 Guidelines — Supraventricular Tachycardia

2019 ESC Guidelines for the management of patients with supraventricular tachycardia

The 2019 guideline moved catheter ablation to first-line therapy for most symptomatic supraventricular tachycardias, which changes the shape of the answer in a large number of questions: the drug is the fallback, not the default.

Acute management is drug-specific and the wrong choices are named. Flecainide and propafenone are not for conversion of atrial flutter; amiodarone is not for pregnant patients; verapamil has no place when the mechanism of a broad complex tachycardia is unknown.

Pre-excitation carries its own recommendations for risk stratification and for the asymptomatic patient. Pregnancy has a defined drug hierarchy. And the patient who declines ablation, or in whom it carries an unacceptable risk of conduction block, is a recurring setup for the drug recommendations that remain.

What is in the bank

129 active questions. Class and level follow the recommendation each question is built from.

Class of recommendation

Class I
56
Class IIa
45
Class IIb
19
Class III
9

Level of evidence

Level A
4
Level B
66
Level C
59

Sample questions

Supraventricular tachycardia · 2019Class IIILevel B
A 64-year-old man has had palpitations for eight hours. His electrocardiogram shows typical atrial flutter with sawtooth waves at 300 per minute in the inferior leads and two-to-one conduction, giving a ventricular rate of 150 beats per minute. He is haemodynamically stable with a blood pressure of 130/82 mmHg. Computed tomography coronary angiography last year showed unobstructed arteries and his echocardiogram is structurally normal, and he has been adequately anticoagulated for six months. The registrar proposes an oral flecainide loading dose, reasoning that flecainide is effective and widely used as a pill in the pocket for atrial fibrillation in patients with structurally normal hearts. What should be given?
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