New ESC guidelines 2019 for the treatment of supraventricular tachycardia

The new guidelines for the management of supraventricular tachycardia (SVT) were published by the European Society of Cardiology (ESC) in September 2019. The key message of the guidelines is that catheter ablation should be offered as a first line treatment to most patients during a comprehensive discussion of the risks and advantages. This recommendation recognizes that catheter ablation has nowadays become a widely established, effective and safe treatment method with a very low complication rate, which has revolutionized the treatment of SVT due to the substantial technical developments in recent years. The new guidelines also include a refinement of the recommendations for the use of antiarrhythmic drug treatment. Most of the previously used medications have been downgraded based on the currently available evidence situation. The recommendations suggest that with the exception of beta blockers and calcium channel blockers, most drugs used to treat SVT are proarrhythmogenic. The occurrence of SVT is associated with a higher risk of complications during pregnancy and the new guidelines provide new and specific recommendations for this patient group. It must be emphasized that all antiarrhythmic drugs should be avoided during the first trimester of pregnancy. It is important to realize that if drug treatment is ineffective, contraindicated or undesired, pregnant women with persistent or recurrent arrhythmia can now be treated with catheter ablation using new techniques that avoid exposing the patient and the fetus to hazardous levels of radiation.