American College of Cardiology

Contact: cfeheley@acc.org; 800-253-4636; 301-581-3425

August 29, 2003

The term SVA is a general term that covers multiple heart rhythm disturbances such as paroxysmal supraventricular tachycardia, atrial flutter or sinus tachycardia. While stress, alcohol, caffeine and illicit drugs such as cocaine can trigger SVAs, most are due to abnormal foci or circuits in the heart. These troublesome arrhythmias can strike at any age, although they usually make their first appearance in young, otherwise healthy individuals with no known cardiovascular disease. A common cause of trips to the emergency room, SVAs are very costly to the health care system.

Because symptoms are often transient and not present when the patient is being examined in the doctor's office, SVAs are a challenge for GPs and cardiologists to diagnose and evaluate. The new guidelines, written by experts who specialize in abnormal cardiac rhythms, detail just how to pinpoint and manage SVAs, and importantly, when to refer patients for more specialized management.

Fortunately, most forms of SVAs can now be cured, thanks to a technique called catheter ablation, say Carina Blomstrom-Lundqvist, MD, and Melvin Scheinman, MD, the co-chairs of the guidelines writing committee. Catheter ablation has made a huge difference in the way SVA patients are managed, said Dr. Scheinman, professor of cardiology at the University of California, San Francisco.

"There has been a sea change in the way we evaluate and treat these patients over the last 10 years. The big new player is catheter ablation, which involves insertion of catheters into blood vessels which allow for passage into the heart in order to locate the site of the abnormal electrical circuit, and then to destroy it by administering radiofrequency energy. There are many different types of catheter ablation techniques, depending on the abnormality. They are the heart and soul of the guidelines," said Dr. Scheinman.

Before the advent of catheter ablation, treatment consisted of drug therapy, or failing drug therapy—open-heart surgery.

"Drugs are palliative. They do not cure these arrhythmias. You have to take the drugs every day, and if you skip a dose, you're liable to have an episode. Plus the drugs have side effects. Catheter ablation gets at the source of the arrhythmia and provides a chance for a total cure," said Dr. Scheinman.

The guidelines also detail how to differentiate arrhythmias originating from the atrium, which are generally benign, from those that come from the ventricle, which are serious and life threatening. "If you have a patient coming in with a broad QRS complex tachycardia, it may be difficult to know whether it's supraventricular or if it's a ventricular tachycardia, so the guidelines specify how to do this," said Dr. Blomstrom-Lundqvist, of University Hospital, Uppsala, Sweden.

"General physicians tend to think that arrhythmias are very difficult to diagnose. We have tried to make it easier for them to understand by providing a framework for the optimal management of patients with SVAs," she added.

The guidelines will also be published in the October 15, 2003 issue of the Journal of the American College of Cardiology, the October 14, 2003 issue of Circulation, and the October 15, 2003 issue of the European Heart Journal. The full text of the updated guidelines will be available electronically at http://www.acc.org/clinical/guidelines/arrhythmias/sva_index.pdf.

The American College of Cardiology, a 29,000-member nonprofit professional medical society and teaching institution, is dedicated to fostering optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines, and the formulation of health care policy.

The American College of Cardiology (ACC) provides these new reports of clinical studies published in the Journal of the American College of Cardiology as a service to physicians, the media, the public, and other interested parties. However, statements or opinions expressed in these reports reflect the view of the author(s) and do not represent official policy of the ACC unless stated so.