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Contact:
cfeheley@acc.org; 800-253-4636; 301-581-3425
August 29, 2003
Guidelines
Issued for Management of Supraventricular Arrhythmias
American and European cardiologists unite
to recommend ways of treating terrifying and potentially dangerous
erratic heart rhythms.
(BETHESDA,
MD)—In a trans-Atlantic first, the American College of
Cardiology (ACC), the American Heart Association (AHA) and the
European Society of Cardiology (ESC) have teamed up to write
guidelines for the management of patients with supraventricular
arrhythmias (SVAs)—rapid, irregular heart beats that cause
palpitations, dizziness, blackouts, and in some instances, death.
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.
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