TABLE 10

Recommendations for Treatment of SVTs in Adults With Congenital Heart Disease

ConditionRecommendationClassificationLevel of EvidenceReferences
Failed antiarrhythmic drugs and symptomatic:
 •Repaired ASDCatheter ablation in an experienced centerIC172,174,175,178,181,210,224,225
 •Mustard or Senning repair of transposition of the great vesselsCatheter ablation in an experienced centerIC175,178,181,210
Unrepaired asymptomatic ASD not hemodynamically significantClosure of the ASD for treatment of the arrhythmiaIIIC208,209
Unrepaired hemodynamically significant ASD with atrial flutterClosure of the ASD combined with ablation of the flutter isthmusIC
PSVT and Ebstein’s anomaly with hemodynamic indications for surgical repairSurgical ablation of accessory pathways at the time of operative repair of the malformation at an experienced centerIC220,226

ASD indicates atrial septal defect; PSVT, paroxysmal supraventricular tachycardia.

  • Conversion and antiarrhythmic drug therapy initial management as described for atrial flutter (see Section V-F).