2019ESC室上性心动过速患者管理指南解读

Interpretation of 2019 ESC guidelines on supraventricular tachycardia

2019年8月31日在2019年欧洲心脏年会上公布了最新欧洲室上性心动过速(室上速,SVT)患者管理指南。普通人群SVT患病率大约为0.2%,女性大约是男性的两倍,65岁以上人群发生率是年轻人群的5倍。该指南提供了对所有类型SVT(房颤除外)的治疗建议。SVT的药物治疗方面自2003年以来没有重要变化,近年来发表了一些有关药物的潜在获益和风险的资料,也出现了一些新型抗心律失常药物。抗心律失常药物主要用于SVT急性发作的终止,长期应用由于疗效差及相关不良反应,临床应用价值有限。16年来临床实践的主要变化是根除心律失常的导管消融技术疗效和安全性不断提高,可以用于大多数SVT患者。妊娠期间发生SVT并发症风险较高,对妊娠女性指南提出了特殊建议。对于妊娠女性应避免使用所有抗心律失常药物,特别是在妊娠前3个月,如果必要一些药物可以谨慎应用。

The new European Society of Cardiology (ESC) Guidelines on supraventricular tachycardia (SVT) are published online on Aug 31, 2019. The prevalence of SVT is approximately 0.2% in the general population. Women have a risk of developing SVT that is two times greater than men, while people over 65 years old have more than five times the risk of developing SVT than younger people. The guidelines provide treatment recommendations for all types of SVT. Drug therapies for SVT have not fundamentally changed since the previous guidelines were published in 2003. Antiarrhythmic drugs are useful for acute episodes. For long-term treatment these drugs are of limited value due to relatively low efficacy and related side-efifects. The main change in clinical practice over the last 16 years is related to the availability of more efficient and safe invasive methods for eradication of the arrhythmia through catheter ablation. SVT is linked with a higher risk of complications during pregnancy and specific recommendations are provided for pregnant women. All antiarrhythmic drugs should be avoided, if possible, especially within the first trimester of pregnancy.