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Cited by 188Cardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmiasAtrial Fibrillation Management and Outcomes

European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE)

Open access
Katritsis, Demosthenes G., Boriani, Giuseppe, Cosio, Francisco G., Hindricks, Gerhard, Jaïs, Pierre, Josephson, Mark E., Keegan, Roberto, Kim, Young-Hoon +23 more·2017·Europace
DOI 10.1093/europace/euw301
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Abstract

atrial tachycardias. . . . . .

AI snapshot

Written from the paper’s full text.

TL;DR

This EHRA consensus document summarizes diagnosis and management of supraventricular arrhythmias other than atrial fibrillation, integrating evidence and expert opinion. It emphasizes ECG/EP diagnosis, acute and chronic drug therapy, and catheter ablation, which is often recommended as first-line therapy in symptomatic SVT.

Key findings

  • In a 3.5% sample of Marshfield Epidemiologic Study Area records, paroxysmal SVT prevalence was 2.25/1000 persons and incidence was 35/100,000 person-years, translating to an estimated 89,000 new cases/year and 570,000 patients with paroxysmal SVT in the USA. Atrial flutter incidence was 88/100,000 person-years, with 200,000 new US cases annually; 58% of AFL patients also had AF.
  • Among 1754 patients undergoing catheter ablation, AVNRT was the most common mechanism (56%), followed by AVRT (27%) and atrial tachycardia (17%). In the first Latin American Catheter Ablation Registry of 15,099 procedures, AVRT was most frequently ablated (31%), followed by AVNRT (29%), typical AFL (14%), and AF (11%).
  • Catheter ablation outcomes: slow pathway ablation for AVNRT had a 95% success rate, 0.5–1% risk of AV block, and 4% recurrence; typical AFL ablation with complete bidirectional cavotricuspid isthmus block had <10% recurrence; focal atrial tachycardia ablation success was 75–100%.
  • In an 8-year prospective registry of 550 initially asymptomatic subjects with ventricular pre-excitation, ventricular fibrillation developed in 2.4% and malignant arrhythmias in 8.7%; risk stratification by electrophysiologic testing and ablation were considered for high-risk features such as accessory pathway anterograde refractory period <240 ms, inducible AVRT triggering pre-excited AF, and multiple accessory pathways.

Methods

  • Design: EHRA consensus document endorsed by HRS, APHRS, and SOLAECE; it is not a primary study and explicitly does not cover atrial fibrillation.
  • Data: narrative synthesis of published evidence and expert opinion from several countries, including cited registries and trials such as MESA, the Latin American Catheter Ablation Registry (15,099 procedures), and prospective WPW registries (550 and 2169 patients).
  • Analysis: consensus recommendations graded with heart symbols; the document states that EHRA grading of consensus statements does not have separate definitions of Level of Evidence and is not directly similar to official society guideline classification/level systems.

Limitations

  • Stated: the document includes evidence and expert opinions from several countries; pharmacologic and non-pharmacologic approaches may include drugs without governmental regulatory approval in all countries; grading is not directly comparable to official society guideline recommendations and lacks separate Level of Evidence definitions.
  • Stated/evident: many recommendations are supported by strong observational evidence and authors’ consensus but no specific RCT; randomized data are limited or absent for several areas, including antiarrhythmic drugs in adult congenital heart disease, pregnancy, anticoagulation in atrial flutter, and asymptomatic WPW (two randomized trials based on small numbers).
  • Evident: the text notes sparse and old epidemiologic data, poor distinction between AF, AFL, and other supraventricular arrhythmias, and many studies that are small, non-randomized, or have short follow-up.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/europace/euw301

Cites

446 of 446 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 467 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    In supraventricular tachycardia, most economic analysis interest has focused on ablation techniques.

    “In the case of SVT most of the interest in economic analysis has been focused on ablation techniques.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    Cheng et al. compared radiofrequency ablation with pharmacological treatment in a Markov model in highly symptomatic adults with monthly supraventricular tachycardia recurrences, excluding patients with Wolff-Parkinson-White syndrome.

    “Cheng et al. compared, in a Markov model, RF ablation vs. pharmacological treatment (continuous or only at the time of arrhythmia recurrence) in highly symptomatic adult patients with monthly recurrences of SVTs, excluding patients with WPW syndrome.247”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [247] Cheng, 2000, Cost-effectiveness of radiofrequency ablation for supraventricular tachycardia, Ann Intern Med source

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  • Findingcitation

    In a 5-year study of patients with mild-to-moderate symptomatic supraventricular tachycardia, Goldberg et al. found that radiofrequency ablation compared with pharmacological treatment was associated with sustained improvement in quality of life and reduction in disease-specific symptoms, particularly in women and patients aged under 50 years.

    “In a 5-year study performed in patients with mild-to-moderate symptomatic SVT, Goldberg et al. found that RF ablation when compared to pharmacological treatment was associated with a sustained improvement in QoL and a reduction in disease-specific symptoms, particularly in women and patients aged ,50 years.254”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [254] Goldberg, 2002, Long-term outcomes on quality-of-life and health care costs in patients with supraventricular tachycardia (radiofrequency catheter ablation versus medical therapy), Am J Cardiol source

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  • Findingcitation

    The foetus has been shown to have a high fibrillation threshold.

    “the foetus has been shown to have a high fibrillation threshold.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [402] Tromp, 2011, Electrical cardioversion during pregnancy: safe or not?, Neth Heart J source

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  • Findingcitation

    Long-term use of atenolol has been associated with intrauterine growth retardation, especially when given in early pregnancy.

    “Long-term use of atenolol has been associated with intrauterine growth retardation, especially when given in early pregnancy, 409”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [409] Lydakis, 1999, Atenolol and fetal growth in pregnancies complicated by hypertension, Am J Hypertens source

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  • Classified as probably not a substantial claim. 35
  • The quote only partly states this claim. 1

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    Findingcitation

    Among calcium channel blockers, experience is greatest with verapamil, which overall appears relatively safe.

    “Among the calcium channel blockers the experience is greatest with verapamil which overall appear to be relatively safe.405”
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    • cites [405] Weber-Schoendorfer, 2008, The safety of calcium channel blockers during pregnancy: a prospective, multicenter, observational study, Reprod Toxicol source

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    Findingcitation

    The exact incidence of paroxysmal supraventricular tachycardia during pregnancy is not well established but appears relatively low.

    “The exact incidence of PSVT during pregnancy is not well established, but seems to be relatively low.395”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [395] Li, 2008, Frequency and outcome of arrhythmias complicating admission during pregnancy: experience from a high-volume and ethnically-diverse obstetric service, Clin Cardiol source

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  • May combine two claims.

    Findingcitation

    Radiofrequency ablation resulted in substantial improvement of quality of life and cost reduction at long term, with a highly favourable dominant cost-utility profile.

    “As shown in Table 20, RF ablation procedures resulted in substantial improvement of QoL and cost reduction at long term, with a highly favourable ('dominant') cost-utility profile.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [247] Cheng, 2000, Cost-effectiveness of radiofrequency ablation for supraventricular tachycardia, Ann Intern Med source

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  • May combine two claims.

    Findingcitation

    Direct current cardioversion can be performed at all stages of pregnancy and is considered safe.

    “Direct current cardioversion can be performed at all stages of pregnancy and is considered safe.402”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [402] Tromp, 2011, Electrical cardioversion during pregnancy: safe or not?, Neth Heart J source

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    Findingcitation

    Catheter ablation has been performed in selected cases and reported effective with minimal maternal and foetal complications.

    “Catheter ablation has been performed in selected cases and has been reported effective with minimal maternal and foetal complications.408”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [408] Driver, 2015, Catheter ablation of arrhythmia during pregnancy, J Cardiovasc Electrophysiol source

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    Findingreasoning

    Consequently, patients with supraventricular tachycardia may restrict normal daily and leisure activities and may be unable to initiate or continue certain high-risk occupations or drive, all of which can adversely affect quality of life.

    “Consequently, patients with SVT may restrict their normal daily and leisure activities (social events, sports, and sexual relationships), 16,419 and may be unable to initiate or continue certain 'high-risk' occupations (flying, competitive athletics etc.) 1,2,419 or drive, 422,423 all of which can adversely affect a patient's QoL.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [1] Blomstrom-Lundqvist, 2003, Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular A. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias), Circulation source

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    • cites [2] Page, 2016, 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society, J Am Coll Cardiol source

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    • cites [419] Lane, 2015, Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE), Europace source

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    • cites [422] Walfridsson, 2005, The impact of supraventricular tachycardias on driving ability in patients referred for radiofrequency catheter ablation, Pacing Clin Electrophysiol source

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    • cites [423] Dhala, 1995, Impairment of driving abilities in patients with supraventricular tachycardias, Am J Cardiol source

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  • May combine two claims.

    Findingcitation

    Almost all studies examining quality of life with validated questionnaires have been conducted in patients undergoing catheter ablation for supraventricular tachycardia, often without a comparison group.

    “Almost all of the studies examining QoL, measured with validated questionnaires, have been conducted in patients undergoing catheter ablation for SVT, 245,246,254 - 256,258,424,425 although often without a comparison group.”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [245] Farkowski, 2014, Gender-related differences in outcomes and resource utilization in patients undergoing radiofrequency ablation of supraventricular tachycardia: results from Patients' Perspective on Radiofrequency Catheter Ablation of AVRT and AVNRT Study, Europace source

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    • cites [246] Wood, 2010, Patient perception of symptoms and quality of life following ablation in patients with supraventricular tachycardia, Heart Lung source

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    • cites [254] Goldberg, 2002, Long-term outcomes on quality-of-life and health care costs in patients with supraventricular tachycardia (radiofrequency catheter ablation versus medical therapy), Am J Cardiol source

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    • cites [255] Larson, 1999, Quality of life before and after radiofrequency catheter ablation in patients with drug refractory atrioventricular nodal reentrant tachycardia, Am J Cardiol source

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    • cites [256] Bubien, 1996, Effect of radiofrequency catheter ablation on health-related quality of life and activities of daily living in patients with recurrent arrhythmias, Circulation source

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    • cites [258] Bathina, 1998, Radiofrequency catheter ablation versus medical therapy for initial treatment of supraventricular tachycardia and its impact on quality of life and healthcare costs, Am J Cardiol source

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    • cites [424] Meissner, 2009, Sustained high quality of life in a 5-year long term follow-up after successful ablation for supra-ventricular tachycardia. results from a large retrospective patient cohort, Int J Med Sci source

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    • cites [425] Yildirim, 2012, The effect of radiofrequency ablation treatment on quality of life and anxiety in patients with supraventricular tachycardia, Eur Rev Med Pharmacol Sci

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    Findingcitation

    Avoidance of overnight stay, with an average cost of $450, resulted in important savings for the institution ($365,000), coupled with a reassuring patient safety profile.

    “Avoidance of overnight stay, with an average cost of $450, resulted in important savings for the institution ($365 000), and this was coupled with a reassuring patient safety profile.418”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [418] Theodoreson, 2015, Same-day cardiac catheter ablation is safe and cost-effective: experience from a UK tertiary center, Heart Rhythm source

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    Findingcitation

    Limitations to participation in social activities and driving are most frequently reported and appear to have the greatest negative impact on quality of life.

    “Limitations to participation in social activities and driving are most frequently reported and appear to have the greatest negative impact on QoL. 419”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [419] Lane, 2015, Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE), Europace source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Robotic techniques and sophisticated anatomical navigation systems have been developed, and it is now possible to perform ablation without exposing the operator to radiation and ergonomically unfavourable positions.

    “Robotic techniques and sophisticated anatomical navigation systems have been developed, and it is now possible to perform ablation without exposing the operator to radiation and ergonomically unfavourable positions.426”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [426] Nakagawa, 2016, Catheter ablation of complex tachyarrhythmias using remote magnetic catheter navigation system, J Cardiovasc Electrophysiol

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Mathematical modelling and numerical analyses have been employed in the investigation of the circuit of atrioventricular nodal reentrant tachycardia.

    “Mathematical modelling and numerical analyses have also been employed in the investigation of the circuit of AVNRT.221,232”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [221] Katritsis, 2015, Atypical atrioventricular nodal reentrant tachycardia: prevalence, electrophysiologic characteristics, and tachycardia circuit, Europace source

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    • cites [232] Katritsis, 2015, Coexistent types of atrioventricular nodal re-entrant tachycardia: implications for the tachycardia circuit, Circ Arrhythm Electrophysiol source

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    Findingcitation

    New data on the genetics of supraventricular tachycardia continually appear since the identification of a missense mutation in PRKAG2 as a cause of familial Wolff-Parkinson-White syndrome.

    “New data on the genetics of SVT continually appear since the identification of a missense mutation in the gene PRKAG2, that encodes the regulatory g-subunit of AMP-activated protein kinase, as a cause of familial Wolff -Parkinson -White syndrome.429,430”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [429] Gollob, 2001, Identification of a gene responsible for familial Wolff-Parkinson-White syndrome, N Engl J Med source

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    • cites [430] Wolf, 2008, Reversibility of PRKAG2 glycogen-storage cardiomyopathy and electrophysiological manifestations, Circulation source

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  • May combine two claims.

    Premisecitation

    In that catheter ablation series, the proportion of AVRT decreased with age, whereas the proportion of AVNRT and AT increased.

    “The proportion of AVRT decreased with age, whereas the proportion of AVNRT and AT increased.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Porter, 2004, Influence of age and gender on the mechanism of supraventricular tachycardia, Heart Rhythm source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    These data translate to 200,000 new cases of AFL in the USA annually, with the arrhythmia being more common in men, the elderly, and individuals with pre-existing heart failure or chronic obstructive lung disease.

    “These data translate to 200 000 new cases of AFL in the USA annually, the arrhythmia being more common in men, the elderly and individuals with pre-existing heart failure or chronic obstructive lung disease.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Granada, 2000, Incidence and predictors of atrial flutter in the general population, J Am Coll Cardiol source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    From those older MESA data, an estimated 89,000 new paroxysmal SVT cases occur annually and 570,000 patients have paroxysmal SVT in the USA.

    “Based on these old data, it was estimated that there are 89 000 new cases per year, and 570 000 patients with paroxysmal SVT in the USA.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Orejarena, 1998, Paroxysmal supraventricular tachycardia in the general population, J Am Coll Cardiol source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In MESA, only 3 subjects (1.7%) were labelled as having 'lone AFL'.

    “Only 3 subjects (1.7%) were labelled as having 'lone AFL'.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Granada, 2000, Incidence and predictors of atrial flutter in the general population, J Am Coll Cardiol source

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    Premisecitation

    Polyuria may be a symptom supportive of a sustained supraventricular arrhythmia, related to release of atrial natriuretic peptide in response to increased atrial pressures; this is most pronounced in AVNRT.

    “Polyuria may be a symptom supportive of a sustained supraventricular arrhythmia, related to the release of atrial natriuretic peptide in response to increased atrial pressures.This is most pronounced in AVNRT.15”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Abe, 1997, Neurohumoral and hemodynamic mechanisms of diuresis during atrioventricular nodal reentrant tachycardia, Pacing Clin Electrophysiol source

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    Premisecitation

    Porter et al. described 1754 patients undergoing catheter ablation, where AVNRT was the most common (56%) aetiology, followed by AVRT 27%, and AT 17%.

    “Porter et al. described 1754 patients undergoing catheter ablation, where AVNRT was the most common (56%) aetiology, followed by AVRT 27%, and atrial tachycardia (AT) 17%. 9”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Porter, 2004, Influence of age and gender on the mechanism of supraventricular tachycardia, Heart Rhythm source

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    Premisecitation

    If irregularity does not exceed 15% of the cycle length, a reentry is possible, while above this threshold, a focal arrhythmia is much more likely.

    “If the irregularity does not exceed 15% of the CL, a reentry is possible, while above this threshold, a focal arrhythmia is much more likely.18”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Jais, 2009, A deductive mapping strategy for atrial tachycardia following atrial fibrillation ablation: importance of localized reentry, J Cardiovasc Electrophysiol source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For AFL, one MESA report of 181 new cases estimated an overall incidence of 88 per 100,000 person-years.

    “For AFL, one report from MESA of 181 new cases of AFL estimated an overall incidence of 88/100 000 person-years.11”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Granada, 2000, Incidence and predictors of atrial flutter in the general population, J Am Coll Cardiol source

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    Premisecitation

    In the first Latin American registry on catheter ablation including 15,099 procedures from 120 centres in 13 countries, AVRT was the most frequently ablated arrhythmia (31%), followed by AVNRT (29%), typical AFL (14%), and AF (11%).

    “Recently, in the first Latin American registry on catheter ablation including 15 099 procedures from 120 centres in 13 participating countries, AVRT was the group of arrhythmias most frequently ablated (31%), followed by AVNRT (29%), typical AFL (14%), and AF (11%).10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Keegan, 2015, The first Latin American Catheter Ablation Registry, Europace source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In MESA, AFL had an incidence of 0.09% and 58% of patients also had AF.

    “In MESA, AFL had an incidence of 0.09% and 58% of the patients also had AF.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Granada, 2000, Incidence and predictors of atrial flutter in the general population, J Am Coll Cardiol source

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    Premisecitation

    An RP cut-off interval of 90 ms has been shown to be useful for surface ECG measurements and can be used if P waves are visible.

    “An cut-off interval of 90 ms has been shown to be useful for surface ECG measurements and can be used if P waves are visible, 20”
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    • cites [20] Letsas, 2010, Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway, Acta Cardiol source

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    Premisecitation

    AFL incidence rates ranged from 5 per 100,000 in those under 50 years old to 587 per 100,000 in subjects older than 80 years.

    “Incidence rates ranged from 5/100 000 in those ,50 years old to 587/100 000 in subjects older than 80 years.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Granada, 2000, Incidence and predictors of atrial flutter in the general population, J Am Coll Cardiol source

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    Premiseown data

    A very short RP interval (<70 ms) rules out AVRT and indicates typical AVNRT or, less commonly, AT as the most likely diagnosis.

    “A very short RP interval (,70 ms) rules out AVRT and indicates typical AVNRT or, less commonly AT, as the most likely diagnosis.The 70 ms cut-off interval is based on VA intervals that have been examined in electrophysiology studies.”
    Quote in the paperSubstantial claim

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    Premisecitation

    Data from specialized centres on paroxysmal SVT patients referred for electrophysiology procedures indicate that patients tend to be younger, have similar age distribution, and lower prevalence of cardiovascular comorbidities.

    “Data from specialized centres reporting on paroxysmal SVT patients referred for electrophysiology procedures, indicate that patients tend to be younger, have similar age distribution, and lower prevalence of cardiovascular comorbidities.5 -7”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [5] Clair, 1993, Spontaneous occurrence of symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia in untreated patients, Circulation source

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    • cites [6] Lu, 2014, Epidemiological profile of Wolff-Parkinson-White syndrome in a general population younger than 50 years of age in an era of radiofrequency catheter ablation, Int J Cardiol source

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    • cites [7] Rodriguez, 1992, Age at onset and gender of patients with different types of supraventricular tachycardias, Am J Cardiol source

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    Premisecitation

    Symptoms may be minimal and prolonged asymptomatic episodes may lead to a tachycardiomyopathy.

    “although symptoms may be minimal and, on certain occasions, prolonged asymptomatic episodes may lead to a tachycardiomyopathy. 14”
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    • cites [14] Ellis, 2013, What about Tachycardia-induced cardiomyopathy?, Arrhythm Electrophysiol Rev source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Atrial flutter was 2.5-fold more common in men.

    “Atrial flutter was 2.5-fold more common in men”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Granada, 2000, Incidence and predictors of atrial flutter in the general population, J Am Coll Cardiol source

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    Premisecitation

    An ECG taken during tachycardia is of key importance for the proper diagnosis of SVT, although it may fail to lead to a specific diagnosis.

    “An ECG taken during tachycardia is of key importance for the proper diagnosis of SVT, although it may fail to lead to a specific diagnosis.17”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Katritsis, 2015, Differential diagnosis of regular, narrow-QRS tachycardias, Heart Rhythm source

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    Premisecitation

    In that series, most patients with AVRT were male (55%), in contrast to patients with AVNRT and AT who were predominantly female (70% and 62%, respectively).

    “Most patients with AVRT were male (55%), in contrast to patients with AVNRT and AT who were predominantly female (70% and 62%, respectively).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Porter, 2004, Influence of age and gender on the mechanism of supraventricular tachycardia, Heart Rhythm source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the Marshfield Epidemiologic Study Area, among a 3.5% sample of medical records, paroxysmal SVT prevalence was 2.25 per 1000 persons and incidence was 35 per 100,000 person-years.

    “In a 3.5% sample of medical records in the Marshfield (Wisconsin) Epidemiologic Study Area (MESA) the prevalence of paroxysmal SVT was 2.25/1000 persons, and the incidence was 35/100 000 person-years. 4”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Orejarena, 1998, Paroxysmal supraventricular tachycardia in the general population, J Am Coll Cardiol source

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    Premisecitation

    Paroxysmal AF is often asymptomatic whilst paroxysmal SVT is usually symptomatic.

    “Paroxysmal AF is often asymptomatic whilst paroxysmal SVT is usually symptomatic, 13”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Page, 1994, Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia, Circulation source

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    Premisecitation

    Wide-QRS tachycardias can be ventricular tachycardias, supraventricular tachycardias conducting with bundle-branch block aberration, or over an accessory pathway, with a reported proportion of 80%, 15% and 5%, respectively.

    “Wide-QRS tachycardias can be ventricular tachycardias, and supraventricular tachycardias conducting with bundle-branch block aberration, or over an accessory pathway, with a reported proportion of 80%, 15% and 5%, respectively (Figure 4).53”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Alzand, 2011, Diagnostic criteria of broad QRS complex tachycardia: decades of evolution, Europace source

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    Premisecitation

    Most VTs, as opposed to SVTs, do not respond to carotid sinus massage, although a narrow-QRS VT originating from the left bundle branch and terminated with carotid sinus massage has been reported.

    “Most VTs, as opposed to SVTs, do not respond to carotid sinus massage, although a narrow-QRS VT originating from the left bundle branch, and terminated with carotid sinus massage has been reported.26”
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    • cites [26] Alzand, 2009, An ‘almost wide’ QRS tachycardia, Circ Arrhythm Electrophysiol source

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    Premisecitation

    The mechanism of inappropriate sinus tachycardia remains poorly understood and is likely multifactorial.

    “The underlying mechanism of inappropriate sinus tachycardia remains poorly understood and is likely to be multifactorial.94”
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    • cites [94] Olshansky, 2013, Inappropriate sinus tachycardia, J Am Coll Cardiol source

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    Premisecitation

    Vagal manoeuvres terminate SVT in 19.4-54% of cases, with higher success when the patient is supine.

    “Effectiveness of vagal manoeuvres in terminating SVT has been reported as between 19.4 -54%, 66 -68 with higher success rates in the supine position.69”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [66] Lim, 1998, Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage, Ann Emerg Med source

      Not checked in the free run.

    • cites [67] Smith, 2015, Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [68] Wen, 1998, Electrophysiological mechanisms and determinants of vagal maneuvers for termination of paroxysmal supraventricular tachycardia, Circulation source

      Not checked in the free run.

    • cites [69] Appelboam, 2015, Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The morphology criteria are not fulfilled in any lead in 4% of SVTs and 6% of VTs, and in a third of cases when one lead (V1 or V6) favours one diagnosis, the other one favours the opposite diagnosis.

    “The morphology criteria are not fulfilled in any lead in 4% of SVTs and 6% of VTs, and in a third of cases when one lead (V 1 or V 6 ) favours one diagnosis, the other one favours the opposite diagnosis (VT in one lead and SVT the other one and vice versa).59”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Brugada, 1991, A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Class Ic and Ia drugs cause use-dependent slowing of conduction, and class III drugs prolong refractoriness at His-Purkinje tissue more than in the ventricular myocardium.

    “Class Ic and Ia drugs cause use-dependent slowing of conduction, and class III drugs prolong refractoriness at His-Purkinje tissue more than in the ventricular myocardium.54,55”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [54] Crijns, 1993, Sequential bilateral bundle branch block during dofetilide, a new class III antiarrhythmic agent, in a patient with atrial fibrillation, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [55] Crijns, 1988, Supraventricular tachycardia mimicking ventricular tachycardia during flecainide treatment, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Electrocardiographic criteria may provide clues suggestive of typical, slow-fast AVNRT, but are of limited value for appropriate differential diagnosis.

    “Thus, electrocardiographic criteria may provide clues suggestive of typical, slow-fast AVNRT, but are of limited value for appropriate differential diagnosis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    This pattern suggests VT with a specificity of more than 90%, but this criterion has low sensitivity being present in <20% of all VTs.

    “This pattern suggests VT with a specificity of more than 90%, but this criterion has low sensitivity being present in ,20% of all VTs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Alzand, 2011, Diagnostic criteria of broad QRS complex tachycardia: decades of evolution, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Positive concordance may occur during antidromic SVT using a left posterior or left lateral accessory pathway, but a negative concordance is nearly always VT.

    “While positive concordance may occur during antidromic SVT using a left posterior or left lateral accessory pathway a negative concordance is nearly always VT. 53”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53] Alzand, 2011, Diagnostic criteria of broad QRS complex tachycardia: decades of evolution, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Adenosine has advantages over IV calcium channel blockers: rapid onset, short half-life, and avoidance of hypotension.

    “The advantages of adenosine relative to IV calcium channel are its rapid onset, the short half-life, and the avoidance of hypotension.71”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [71] Delaney, 2011, The relative efficacy of adenosine versus verapamil for the treatment of stable paroxysmal supraventricular tachycardia in adults: a meta-analysis, Eur J Emerg Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Inappropriate sinus tachycardia tends to be persistent, and most affected patients are young and female, though not limited to that population.

    “The tachycardia tends to be persistent and most of the affected patients are young and female, but this disorder is not limited to that population.95”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [95] Still, 2005, Prevalence, characteristics and natural course of inappropriate sinus tachycardia, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A taller right rabbit ear characterizes RBBB aberrancy but does not exclude VT.

    “A taller right rabbit ear characterizes the RBBB aberrancy but does not exclude VT. 57”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Garner, 2013, Wide complex tachycardia—ventricular tachycardia or not ventricular tachycardia, that remains the question, Arrhythm Electrophysiol Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In true LBBB, no Q wave is present in the lateral precordial leads; therefore, the presence of any Q or QS wave in lead V6 favours VT.

    “In true LBBB, no Q wave is present in the lateral precordial leads.Therefore, the presence of any Q or QS wave in lead V6 favours VT. 56”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [56] Wellens, 1978, The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex, Am J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There has been one report on the analysis of 267 wide-QRS tachycardias, consisting of VT and antidromic AVRT; the derived criteria were found to offer sensitivity of 75% and specificity of 100%.

    “There has been one report on the analysis of 267 wide-QRS tachycardias, consisting of VT and antidromic AVRT.The derived criteria were found to offer sensitivity of 75% and specificity of 100%, 63”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Steurer, 1994, The differential diagnosis on the electrocardiogram between ventricular tachycardia and preexcited tachycardia, Clin Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In POTS, tachycardia occurs gradually when moving from supine to upright, in the absence of orthostatic hypotension, unlike IST.

    “as opposed to inappropriate sinus tachycardia, in POTS the tachycardia occurs gradually moving from supine to upright position in the absence of orthostatic hypotension.93”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [93] Sheldon, 2015, 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope, Heart Rhythm source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These criteria are specific (91-100%) but modestly sensitive (58-14%).

    “These criteria are specific (91-100%) but modestly sensitive (58-14%).22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Kalbfleisch, 1993, Differentiation of paroxysmal narrow QRS complex tachycardias using the 12-lead electrocardiogram, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In sinus node reentrant tachycardia, heart rate can shift suddenly at initiation, as opposed to the gradual increase in inappropriate sinus tachycardia.

    “the heart rate can shift suddenly at initiation of sinus node reentrant tachycardia, as opposed to the gradual increase of the inappropriate sinus tachycardia rate;”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [92] Gomes, 1985, Sustained symptomatic sinus node reentrant tachycardia: incidence, clinical significance, electrophysiologic observations and the effects of antiarrhythmic agents, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Beta blockers and calcium-channel blockers may be effective for chronic AT with low risk of side effects.

    “Beta blockers and calcium-channel blockers may be effective and there is a low risk of side effects.113,114”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [113] Mehta, 1988, Ectopic automatic atrial tachycardia in children: clinical characteristics, management and follow-up, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [114] Yamabe, 2014, Demonstration of anatomic reentrant circuit in verapamil-sensitive atrial tachycardia originating from the atrioventricular annulus other than the vicinity of the atrioventricular node, Am J Cardiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Most studies report no gender impact on focal AT prevalence.

    “Most studies reported no gender impact on prevalence.7”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Rodriguez, 1992, Age at onset and gender of patients with different types of supraventricular tachycardias, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Multifocal atrial tachycardia is not a good indication for catheter ablation, and metoprolol has been found superior to verapamil, but should be used with caution because pulmonary disease is frequent in MAT.

    “Multifocal atrial tachycardia is not a good indication for catheter ablation, and metoprolol has been found superior to verapamil, but should be used with caution as pulmonary disease is frequent in MAT (Table 11).106,117”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [106] Arsura, 1988, A randomized, double-blind, placebo-controlled study of verapamil and metoprolol in treatment of multifocal atrial tachycardia, Am J Med source

      Not checked in the free run.

    • cites [117] Hazard, 1987, Treatment of multifocal atrial tachycardia with metoprolol, Crit Care Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In centrifugal arrhythmias such as focal AT and localized reentry, activation originates from a source and spreads centrifugally; in macro-reentries, activation follows a large path around a central obstacle and reenters.

    “In centrifugal arrhythmias, (such as focal AT and localized reentry) the activation originates from a source and spreads centrifugally to the rest of the atria, while in macro-reentries, it follows a large path around a central obstacle and reenters.18”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Jais, 2009, A deductive mapping strategy for atrial tachycardia following atrial fibrillation ablation: importance of localized reentry, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Complications of sinus node modification may occur in up to 14% and include cardiac tamponade, SVC syndrome, diaphragmatic paralysis due to phrenic nerve palsy, and sinus node dysfunction requiring permanent pacing.

    “Complications of sinus node modification may occur in up to 14% of cases, and include cardiac tamponade, SVC syndrome, diaphragmatic paralysis due to phrenic nerve palsy, and sinus node dysfunction with the need for permanent pacing.88 -90”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [88] Gianni, 2016, Catheter ablation of inappropriate sinus tachycardia, J Interv Card Electrophysiol source

      Not checked in the free run.

    • cites [89] Jacobson, 2014, Epicardial/endocardial sinus node ablation after failed endocardial ablation for the treatment of inappropriate sinus tachycardia, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [90] Leonelli, 2000, Frequency of superior vena cava syndrome following radiofrequency modification of the sinus node and its management, Am J Cardiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Focal atrial tachycardia prevalence in asymptomatic young people is 0.34%, and 0.46% in symptomatic patients.

    “In asymptomatic young people the prevalence of focal AT has been reported to be as low as 0.34%, with an increased prevalence of 0.46% in symptomatic patients.99”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [99] Poutiainen, 1999, Prevalence and natural course of ectopic atrial tachycardia, Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Verapamil, digoxin, and amiodarone have variable success in sinus node reentrant tachycardia; beta-blockers are often ineffective; ivabradine likely has minimal benefit.

    “Verapamil, digoxin, and amiodarone have demonstrated variable success while beta-blockers are often ineffective, and the potential benefit of ivabradine is likely to be minimal.92,98”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [92] Gomes, 1985, Sustained symptomatic sinus node reentrant tachycardia: incidence, clinical significance, electrophysiologic observations and the effects of antiarrhythmic agents, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [98] Yusuf, 2003, Sinus tachyarrhythmias and the specific bradycardic agents: a marriage made in heaven?, J Cardiovasc Pharmacol Ther source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Class Ia, Ic, and III drugs may be effective for chronic AT if first-line therapy failed, but Ia and Ic agents should ideally be combined with AV node blocking agents.

    “Class Ia, Ic, and III drugs may be effective if first-line therapy has failed, but Ia and Ic agents should be ideally combined associated with AV node blocking agents.107 -109,115,116”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [107] Hohnloser, 1992, Short- and long-term efficacy and safety of flecainide acetate for supraventricular arrhythmias, Am J Cardiol source

      Not checked in the free run.

    • cites [108] Kunze, 1986, Effect of encainide and flecainide on chronic ectopic atrial tachycardia, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [109] Coumel, 1980, Amiodarone in the treatment of cardiac arrhythmias in children: one hundred thirty-five cases, Am Heart J source

      Not checked in the free run.

    • cites [115] Heusch, 1994, Clinical experience with propafenone for cardiac arrhythmias in the young, Eur Heart J source

      Not checked in the free run.

    • cites [116] Colloridi, 1992, Oral sotalol in pediatric atrial ectopic tachycardia, Am Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    AT is considered a benign condition, but cases of tachycardiomyopathy have been described.

    “AT is considered a benign condition, but cases of tachycardiomyopathy have been described.102”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [102] Chen, 1998, Focal atrial tachycardia: reanalysis of the clinical and electrophysiologic characteristics and prediction of successful radiofrequency ablation, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Localized reentries are small reentrant circuits with diameter less than 2-3 cm.

    “Localized reentries are small reentrant circuits, with a diameter that is less than 2 -3 cm.118”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [118] Jais, 2000, Mapping and ablation of left atrial flutters, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    24-h Holter monitoring in IST characteristically shows a mean heart rate above 90 bpm with an exaggerated heart rate response above 100 bpm during waking hours.

    “The 24-h Holter monitoring characteristically demonstrates a mean HR .90bpm with an exaggerated HR response .100bpm during the waking hours.95”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [95] Still, 2005, Prevalence, characteristics and natural course of inappropriate sinus tachycardia, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Intravenous adenosine has been shown to terminate AT, particularly focal, but the tachycardia may continue with AV block.

    “Intravenous adenosine has been shown to terminate AT, particularly when there is a focal origin, but the tachycardia may continue with AV block.103,105”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [103] Markowitz, 1999, Differential effects of adenosine on focal and macroreentrant atrial tachycardia, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [105] Kall, 1995, Adenosine-sensitive atrial tachycardia, Pacing Clin Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Focal AT may arise from any site in both atria, but crista terminalis, tricuspid and mitral valve annulus, and thoracic veins joining the atria are sites of predilection.

    “Focal AT may arise from any site in both atria, but crista terminalis, tricuspid and mitral valve annulus, and within the thoracic veins joining to the atria, are sites of predilection.101”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [101] Teh, 2009, Using the 12-lead ECG to localize the origin of ventricular and atrial tachycardias: part 1. Focal atrial tachycardia, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sinus node reentrant tachycardia is easily and reproducibly induced with programmed atrial stimulation, unlike inappropriate sinus tachycardia.

    “sinus node reentrant tachycardia is easily and reproducibly induced with programmed atrial stimulation differently from inappropriate sinus tachycardia;”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [92] Gomes, 1985, Sustained symptomatic sinus node reentrant tachycardia: incidence, clinical significance, electrophysiologic observations and the effects of antiarrhythmic agents, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a double-blind randomized placebo-controlled crossover trial of 21 patients, ivabradine eliminated 75% of IST-related symptoms, with nearly 50% experiencing prompt complete resolution in short-term follow-up.

    “In a double-blind, randomized, placebo-controlled trial with a crossover design on 21 patients, 75% of inappropriate sinus tachycardia-related symptoms were eliminated in the ivabradine cohort, with nearly 50% of patients experiencing prompt and complete resolution of all symptoms in a short-term follow-up.85”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [85] Cappato, 2012, Clinical efficacy of ivabradine in patients with inappropriate sinus tachycardia: a prospective, randomized, placebo-controlled, double-blind, crossover evaluation, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ivabradine is a selective If current blocker that slows heart rate without affecting intraventricular conduction, contractility, or haemodynamics, and has been found safe and effective in multiple small trials.

    “ivabradine, a selective If current blocker that directly slows the HR without influence on intraventricular conduction, contractility, or haemodynamics, has been found safe and effective in multiple small trials (Table 9).85,86”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [85] Cappato, 2012, Clinical efficacy of ivabradine in patients with inappropriate sinus tachycardia: a prospective, randomized, placebo-controlled, double-blind, crossover evaluation, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [86] Ptaszynski, 2013, Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Atrial overdrive pacing can localize the focus of focal AT because the post-pacing interval increases with increasing distance from the source.

    “Atrial overdrive pacing can be used to localize the focus of these tachycardias, since the PPI increases with increasing distance from the source.100”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [100] Mohamed, 2007, A novel pacing maneuver to localize focal atrial tachycardia, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a study of 20 patients, ivabradine had a similar effect on resting heart rate as metoprolol but was more effective in relieving symptoms during exercise or daily activity and was better tolerated.

    “In a more recent study of 20 patients, ivabradine had a similar effect on resting heart rate as metoprolol but was more effective in relieving symptoms during exercise or daily activity, and was better tolerated.86”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [86] Ptaszynski, 2013, Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Adenosine injection can help by terminating focal AT or by slowing the ventricular rate.

    “Adenosine injection can help by terminating focal AT or by slowing the ventricular rate.103”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [103] Markowitz, 1999, Differential effects of adenosine on focal and macroreentrant atrial tachycardia, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The reentry mechanism of typical AFL is supported by a line of conduction block in the posterior RA extending from IVC toward SVC, most often related to anisotropic conduction at the crista terminalis, though other posterior RA structures may play a role.

    “The reentry mechanism is supported by a line of conduction block in the posterior RA, extending from the IVC toward the SVC, most often related to anisotropic conduction at the crista terminalis, 123 although other structures of the posterior RA may also play a role.124”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [123] Olgin, 1995, Role of right atrial endocardial structures as barriers to conduction during human type I atrial flutter. Activation and entrainment mapping guided by intracardiac echocardiography, Circulation source

      Not checked in the free run.

    • cites [124] Friedman, 2000, Global right atrial mapping of human atrial flutter: the presence of posteromedial (sinus venosa region) functional block and double potentials : a study in biplane fluoroscopy and intracardiac echocardiography, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Amiodarone may not be very effective acutely to reestablish sinus rhythm in AFL, but helps control ventricular rate if it is too fast.

    “Amiodarone may not be very effective acutely to reestablish sinus rhythm, but it does help control ventricular rate if it is too fast.143,144”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [143] Bianconi, 2000, Comparison of intravenously administered dofetilide versus amiodarone in the acute termination of atrial fibrillation and flutter. A multicentre, randomized, double-blind, placebo-controlled study, Eur Heart J source

      Not checked in the free run.

    • cites [144] Kafkas, 2007, Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter, Int J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Systemic embolism occurs in AFL about 30% as frequently as in AF, a difference that disappears when AFL is associated with AF episodes.

    “Systemic embolism occurs in AFL about 30% as frequently as in AF, 168 -170 a difference that disappears when AFL is associated with AF episodes.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [168] Biblo, 2001, Risk of stroke in patients with atrial flutter, Am J Cardiol source

      Not checked in the free run.

    • cites [169] Wood, 1997, Risk of thromboembolism in chronic atrial flutter, Am J Cardiol source

      Not checked in the free run.

    • cites [170] Seidl, 1998, Risk of thromboembolic events in patients with atrial flutter, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Rate control is a particularly difficult goal in AFL, and even combination of AV node blocking drugs may fail, making cardioversion necessary.

    “This is a particularly difficult goal in AFL and even the combination of AV node blocking drugs (digoxin, b blockers, calcium channel blockers) 135 -137 may fail, making cardioversion to sinus rhythm necessary.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [135] Ellenbogen, 1991, A placebo-controlled trial of continuous intravenous diltiazem infusion for 24-hour heart rate control during atrial fibrillation and atrial flutter: a multicenter study, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [136] Platia, 1989, Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter, Am J Cardiol source

      Not checked in the free run.

    • cites [137] Salerno, 1989, Efficacy and safety of intravenous diltiazem for treatment of atrial fibrillation and atrial flutter. The Diltiazem-Atrial Fibrillation/Flutter Study Group, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Adenosine can produce a rebound increase of AV conduction to 1:1 and may precipitate AF.

    “However, adenosine can produce a rebound increase of AV conduction to 1:1, and may also precipitate AF. 177,178”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [177] Brodsky, 1994, Enhanced atrioventricular conduction during atrial flutter after intravenous adenosine, N Engl J Med source

      Not checked in the free run.

    • cites [178] Strickberger, 1997, Adenosine-induced atrial arrhythmia: a prospective analysis, Ann Intern Med source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In scar-related areas of block, the ECG pattern may not be typical, and conversely a typical AFL ECG may be produced by atypical MRT even due to LA circuits.

    “In these cases with scar-related areas of block the ECG pattern may not Table 12 Therapy of atrial flutter/ macro-reentrant tachycardia Recommendation Reference Acute therapy Synchronised DC cardioversion is recommended for haemodynamically unstable patients with AFL/MRT a 131,132 IV anticoagulation may be considered in case emergency cardioversion is necessary.Anticoagulation should be continued”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [159] Lukac, 2005, Ablation of atrial tachycardia after surgery for congenital and acquired heart disease using an electroanatomic mapping system: which circuits to expect in which substrate?, Heart Rhythm source

      Not checked in the free run.

    • cites [160] Coffey, 2013, Catheter ablation of scar-related atypical atrial flutter, Europace source

      Not checked in the free run.

    • cites [171] Bochoeyer, 2003, Surface electrocardiographic characteristics of right and left atrial flutter, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Catheter ablation for focal AT has a reported success rate of 75-100% and has been shown superior to antiarrhythmic drugs in a randomized study in the context of AF ablation.

    “Catheter ablation is reported to have a 75 -100% success rate, 111,120 and has been shown superior to antiarrhythmic drugs in a randomized study in the context of AF ablation.112”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [111] Anguera, 2001, Outcomes after radiofrequency catheter ablation of atrial tachycardia, Am J Cardiol source

      Not checked in the free run.

    • cites [120] Hoffmann, 2002, Clinical experience with electroanatomic mapping of ectopic atrial tachycardia, Pacing Clin Electrophysiol source

      Not checked in the free run.

    • cites [112] Zhang, 2014, Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: a randomized clinical trial, Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    If complete block is present, the superior turning point is the atrial roof between SVC and tricuspid ring; otherwise it may be at different levels of the postero-lateral wall across the crista terminalis.

    “If complete block is present, the superior turning point is the atrial roof, between the superior vena cava (SVC) and the tricuspid ring, but in other cases the turning point may be at different levels of the postero-lateral wall, across the crista terminalis.125 -127”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [125] Cheng, 1999, Right atrial flutter due to lower loop reentry: mechanism and anatomic substrates, Circulation source

      Not checked in the free run.

    • cites [126] Dixit, 2011, Noncontact electroanatomic mapping to characterize typical atrial flutter: participation of right atrial posterior wall in the reentrant circuit, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [127] Santucci, 2009, Electroanatomic mapping of postpacing intervals clarifies the complete active circuit and variants in atrial flutter, Heart Rhythm source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Localized reentries are localized in one segment of the atrium and depend on a very slow conduction area showing long-duration fragmented signal encompassing more than half the cycle length, which is the target for ablation.

    “They are localized in one segment of the atrium and depend on a very slow conduction area showing a very long duration and fragmented signal which usually encompass more than half the cycle length and are the target for ablation.119”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [119] Takahashi, 2009, Electrophysiological characteristics of localized reentrant atrial tachycardia occurring after catheter ablation of long-lasting persistent atrial fibrillation, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Multiple circuits are possible in AFL, including CTI-dependent AFL which remains the most common type even after surgery or ablation.

    “Multiple circuits are possible, including CTI-dependent AFL which still is the most common type even in these situations.11,159,160”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [11] Granada, 2000, Incidence and predictors of atrial flutter in the general population, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [159] Lukac, 2005, Ablation of atrial tachycardia after surgery for congenital and acquired heart disease using an electroanatomic mapping system: which circuits to expect in which substrate?, Heart Rhythm source

      Not checked in the free run.

    • cites [160] Coffey, 2013, Catheter ablation of scar-related atypical atrial flutter, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In AFL lasting >48h, risk of thromboembolism appears high at the time of cardioversion to sinus rhythm by DC shock, atrial stimulation, or CTI ablation, and anticoagulation is recommended as in AF.

    “In patients with AFL lasting .48h the risk of thromboembolism would appear high at the time of cardioversion to sinus rhythm, either by DC shock, atrial stimulation or CTI ablation, 133,134 and anticoagulation is recommended as in AF.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [133] Grimm, 1997, Left atrial appendage ‘stunning’ after electrical cardioversion of atrial flutter: an attenuated response compared with atrial fibrillation as the mechanism for lower susceptibility to thromboembolic events, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [134] Irani, 1997, Prevalence of thrombus, spontaneous echo contrast, and atrial stunning in patients undergoing cardioversion of atrial flutter. A prospective study using transesophageal echocardiography, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dofetilide and ibutilide, pure class III AADs, are very effective for interrupting AFL intravenously, while class Ia and Ic drugs have little or no effect.

    “Dofetilide and ibutilide, pure class III AADs, are very effective for interrupting AFL in intravenous administration, while Class Ia and Ic drugs have little or no effect.138 -142,149”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [138] Crijns, 1994, Atrial flutter can be terminated by a class III antiarrhythmic drug but not by a class IC drug, Eur Heart J source

      Not checked in the free run.

    • cites [139] Falk, 1997, Intravenous dofetilide, a class III antiarrhythmic agent, for the termination of sustained atrial fibrillation or flutter. Intravenous Dofetilide Investigators, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [140] Stambler, 1997, Antiarrhythmic actions of intravenous ibutilide compared with procainamide during human atrial flutter and fibrillation: electrophysiological determinants of enhanced conversion efficacy, Circulation source

      Not checked in the free run.

    • cites [141] Volgman, 1998, Conversion efficacy and safety of intravenous ibutilide compared with intravenous procainamide in patients with atrial flutter or fibrillation, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [142] Vos, 1998, Superiority of ibutilide (a new class III agent) over DL-sotalol in converting atrial flutter and atrial fibrillation. The Ibutilide/Sotalol Comparator Study Group, Heart source

      Not checked in the free run.

    • cites [149] Singh, 2000, Efficacy and safety of oral dofetilide in converting to and maintaining sinus rhythm in patients with chronic atrial fibrillation or atrial flutter: the symptomatic atrial fibrillation investigative research on dofetilide (SAFIRE-D) study, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The 'lower loop' circuit can be considered a variant of typical atrial flutter in which activation crosses the posterior right atrium and crista terminalis at a lower level than usual, and the ECG often shows a typical flutter pattern.

    “the so called 'lower loop' circuit could be considered a variation of typical AFL in which the activation crosses the posterior RA and TC at a lower level than usual, and the ECG tends to show a typical AFL pattern.125”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [125] Cheng, 1999, Right atrial flutter due to lower loop reentry: mechanism and anatomic substrates, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Peri-mitral or roof-dependent macroreentrant tachycardia may occur in 4% to 20% of atrial fibrillation ablation cases, with higher rates after linear or fractionated electrogram ablation techniques.

    “Peri-mitral or roof-dependent MRT may occur in 4-20% of AF ablation cases, being higher with linear or fractionated electrogram ablation techniques.119,197,198”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [119] Takahashi, 2009, Electrophysiological characteristics of localized reentrant atrial tachycardia occurring after catheter ablation of long-lasting persistent atrial fibrillation, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [197] Wasmer, 2012, Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation, Heart Rhythm source

      Not checked in the free run.

    • cites [198] Rostock, 2013, Prognostic role of subsequent atrial tachycardias occurring during ablation of persistent atrial fibrillation: a prospective randomized trial, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Two randomized studies found catheter ablation superior to antiarrhythmic drugs for atrial flutter recurrence, quality of life, repeat hospitalization, and drug side effects.

    “Two randomized studies have shown the superiority of catheter ablation over AAD in terms of AFL recurrence, quality of life, repeat hospitalization and AAD side effects.153,154”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [153] Da Costa, 2006, Results from the Loire-Ardeche-Drome-Isere-Puy-de-Dome (LADIP) trial on atrial flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter, Circulation source

      Not checked in the free run.

    • cites [154] Natale, 2000, Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Atypical, surgery-related atrial flutter/macroreentrant tachycardia often occurs years after surgery, suggesting that atrial remodeling may be needed for stable reentry around the surgical obstacle.

    “Atypical, surgery-related AFL/MRT often occurs years after the procedure, suggesting that an atrial remodelling process may be necessary to make reentry stable around the surgical obstacle.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Atrial fibrillation after flutter ablation is more likely in patients with prior atrial fibrillation episodes and in those with a dilated left atrium.

    “AF is more likely in patients having had AF episodes before ablation and in those with a dilated LA. 187”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [187] Ellis, 2007, Incidence of atrial fibrillation post-cavotricuspid isthmus ablation in patients with typical atrial flutter: left-atrial size as an independent predictor of atrial fibrillation recurrence, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The ECG pattern of atypical flutter is difficult to relate to its mechanism because slow conduction segments in reentry pathways can produce isoelectric lines and atrial waves may reflect activation outside the circuit.

    “The ECG pattern is difficult to relate to the mechanism, since slow conduction segments in reentry pathways may produce isoelectric lines and the atrial waves may reflect activation outside the circuit.171”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [171] Bochoeyer, 2003, Surface electrocardiographic characteristics of right and left atrial flutter, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Complete, persistent, bidirectional cavotricuspid isthmus block is the procedural endpoint, and when achieved, arrhythmia recurrence occurs in less than 10% of cases.

    “Complete, persistent, bidirectional CTI block is the procedure endpoint, and, if attained, recurrence of the arrhythmia is seen in ,10% of cases.181,182”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [181] Shah, 2000, Differential pacing for distinguishing block from persistent conduction through an ablation line, Circulation source

      Not checked in the free run.

    • cites [182] Schwartzman, 1996, Conduction block in the inferior vena caval-tricuspid valve isthmus: association with outcome of radiofrequency ablation of type I atrial flutter, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with complex congenital heart disease who undergo Mustard, Senning, or Fontan procedures, complex suture lines and extensive myocardial damage create multiple substrates, while the cavotricuspid isthmus often remains a critical isthmus in the reentry circuit with difficult access for ablation.

    “In patients with complex congenital heart disease undergoing the Mustard, Senning, or Fontan procedures, complex suture lines and large areas of myocardial damage create multiple substrates while in many cases the CTI is still a critical isthmus in the reentry circuit, with a difficult access for ablation.195,196”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [195] Collins, 2000, Location of acutely successful radiofrequency catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease, Am J Cardiol source

      Not checked in the free run.

    • cites [196] Zrenner, 2003, Delineation of intra-atrial reentrant tachycardia circuits after mustard operation for transposition of the great arteries using biatrial electroanatomic mapping and entrainment mapping, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Macroreentrant tachycardia circuits may rotate around the superior vena cava and upper crista terminalis ('upper loop') or around a lateral right atrial surgical scar or a septal patch.

    “MRT circuits may turn around the SVC and the upper portions of the crista terminalis ('upper loop') or around a lateral RA surgical scar or a septal patch.159,194”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [159] Lukac, 2005, Ablation of atrial tachycardia after surgery for congenital and acquired heart disease using an electroanatomic mapping system: which circuits to expect in which substrate?, Heart Rhythm source

      Not checked in the free run.

    • cites [194] Kall, 2000, Atypical atrial flutter originating in the right atrial free wall, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dofetilide is moderately effective for converting atrial fibrillation or flutter to sinus rhythm and significantly effective for maintaining sinus rhythm, but in-hospital initiation and dose adjustment based on QTc and renal function are needed to minimize a small but not negligible proarrhythmic risk.

    “Dofetilide is moderately effective in cardioverting AF or AFL to SR, and significantly effective in maintaining SR but in-hospital initiation and dosage adjustment based on QTc and renal function are necessary to minimize a small but not negligible proarrhythmic risk.149”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [149] Singh, 2000, Efficacy and safety of oral dofetilide in converting to and maintaining sinus rhythm in patients with chronic atrial fibrillation or atrial flutter: the symptomatic atrial fibrillation investigative research on dofetilide (SAFIRE-D) study, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Complications of cavotricuspid isthmus ablation are infrequent and usually limited to vascular access, though in-hospital mortality of 0.17% has been reported.

    “Complications of CTI ablation are infrequent, and usually limited to the vascular access, although a 0.17% in-hospital mortality has been reported.161”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [161] Patel, 2016, Contemporary utilization and safety outcomes of catheter ablation of atrial flutter in the United States: analysis of 89,638 procedures, Heart Rhythm source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    After cavotricuspid isthmus ablation, long-term prognosis is affected by atrial fibrillation, which can occur in 30% to 50% of patients over 5 to 8 years.

    “However, post-ablation prognosis is affected by the incidence of AF that can be 30 -50% in the long term (5-8 years).175”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [175] Luria, 2008, Effect of radiofrequency ablation of atrial flutter on the natural history of subsequent atrial arrhythmias, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    This high incidence has been related to inflammatory changes in the atrial myocardium, similar to experimental pericarditis animal models, and may be prevented by anti-inflammatory corticosteroid or colchicine treatment.

    “This high incidence has been related to inflammatory changes in the atrial myocardium, 213 not unlike the experimental pericarditis animal models, and it may be prevented by anti-inflammatory corticosteroid or colchicine treatment.214”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [213] Ishii, 2005, Inflammation of atrium after cardiac surgery is associated with inhomogeneity of atrial conduction and atrial fibrillation, Circulation source

      Not checked in the free run.

    • cites [214] Ho, 2009, Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery: a dose-response meta-analysis, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    After atrial fibrillation maze surgery, macroreentrant tachycardia may depend on breaks in the surgical ablation lines that can be localized by endocardial mapping, allowing interruption by localized ablation at those sites.

    “After AF 'maze' surgery, MRT may depend on breaks of the surgical ablation lines that can be localized by endocardial mapping allowing interruption of the MRT by localized ablation at these sites.201,202”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [201] Akar, 2007, Surface electrocardiographic patterns and electrophysiologic characteristics of atrial flutter following modified radiofrequency MAZE procedures, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [202] McElderry, 2008, Proarrhythmic aspects of atrial fibrillation surgery: mechanisms of postoperative macroreentrant tachycardias, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Extensive left atrial ablation beyond pulmonary vein isolation carries a potentially increased risk of macroreentrant or focal iatrogenic atrial tachycardias, and its value is not well established in patients with paroxysmal or persistent atrial fibrillation.

    “However, these techniques carry a potentially increased risk of macroreentrant or focal iatrogenic atrial tachycardias, 197,207 and their value is rather not established in patients with paroxysmal or persistent AF. 208 -210”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [197] Wasmer, 2012, Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation, Heart Rhythm source

      Not checked in the free run.

    • cites [207] O'Neill, 2009, Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint, Eur Heart J source

      Not checked in the free run.

    • cites [208] McLellan, 2015, A minimal or maximal ablation strategy to achieve pulmonary vein isolation for paroxysmal atrial fibrillation: a prospective multi-centre randomized controlled trial (the Minimax study), Eur Heart J source

      Not checked in the free run.

    • cites [209] Verma, 2015, Catheter Ablation for Persistent Atrial Fibrillation, N Engl J Med

      Not checked in the free run.

    • cites [210] Vogler, 2015, Pulmonary vein isolation versus defragmentation: the CHASE-AF clinical trial, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ablation of atypical atrial flutter/macroreentrant tachycardia is more challenging and has a lower success rate and higher recurrence rate than cavotricuspid isthmus ablation.

    “Atypical AFL/MRT ablation can be very challenging and has a lower success rate and a higher recurrence rate than CTI ablation.163,164,204 -206”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [163] Bai, 2007, Radiofrequency ablation of atypical atrial flutter after cardiac surgery or atrial fibrillation ablation: a randomized comparison of open-irrigation-tip and 8-mm-tip catheters, Heart Rhythm source

      Not checked in the free run.

    • cites [164] Matsuo, 2010, Peri-mitral atrial flutter in patients with atrial fibrillation ablation, Heart Rhythm source

      Not checked in the free run.

    • cites [204] Miyazaki, 2015, Recurrent spontaneous clinical perimitral atrial tachycardia in the context of atrial fibrillation ablation, Heart Rhythm source

      Not checked in the free run.

    • cites [205] Aktas, 2010, Higher rate of recurrent atrial flutter and atrial fibrillation following atrial flutter ablation after cardiac surgery, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [206] Bai, 2012, Ablation of perimitral flutter following catheter ablation of atrial fibrillation: impact on outcomes from a randomized study (PROPOSE), J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Vagal manoeuvres for orthodromic AVRT can be first-line treatment with a success rate of approximately 50%.

    “Non-invasive approaches for orthodromic AVRT with vagal manoeuvres, including Valsalva and carotid sinus massage, could represent the first-line treatment with a success rate of approximately 50% (Table 16).66 -68”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [66] Lim, 1998, Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage, Ann Emerg Med source

      Not checked in the free run.

    • cites [67] Smith, 2015, Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [68] Wen, 1998, Electrophysiological mechanisms and determinants of vagal maneuvers for termination of paroxysmal supraventricular tachycardia, Circulation source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    These findings suggest that some remodeling or maturation process may be necessary before a macroreentrant tachycardia circuit becomes stable, and that a new ablation procedure early after atrial fibrillation ablation should not be indicated unless tachycardia does not respond to antiarrhythmic drugs.

    “This would suggest that some kind of remodelling or maturation process may be necessary before a MRT tachycardia circuit becomes stable, and that a new ablation procedure early after AF ablation should not be indicated, unless tachycardia does not respond to antiarrhythmic drugs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In atrial flutter after atrial fibrillation ablation, more than one tachycardia mechanism often coexists, both macroreentrant and focal, sometimes making circuit identification difficult, particularly when entrainment maneuvers change activation.

    “In post-AF ablation AFL, more than one tachycardia mechanisms often coexist, both MRT and focal, 157,203 making sometimes difficult to identify the circuits' structures, particularly when entrainment manoeuvres result in changes in activation.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [157] Chae, 2007, Atrial tachycardia after circumferential pulmonary vein ablation of atrial fibrillation: mechanistic insights, results of catheter ablation, and risk factors for recurrence, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [203] Gerstenfeld, 2004, Mechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Thus, multiple cell sources participating in the AV node may contribute to its heterogeneity and form the substrate underlying AV nodal reentrant tachycardia.

    “Thus, multiple sources of cells that participate in the AV node may play a role in its heterogeneity, and form the substrate underlying AV nodal reentrant tachycardia.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The incidence of atrial arrhythmias in the early postoperative period after coronary artery bypass surgery is 20% to 30%.

    “The incidence of atrial arrhythmias in the early postoperative period (days) after coronary artery by-pass surgery, is 20-30%.212”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [212] Frost, 1992, Atrial fibrillation and flutter after coronary artery bypass surgery: epidemiology, risk factors and preventive trials, Int J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In many patients, attacks manifest early in life, while in a substantial proportion atrioventricular nodal reentrant tachycardia starts only in the fourth or fifth decade.

    “In many patients attacks indeed manifest early in life, whereas in a substantial proportion of patients AVNRT starts only in the 4th or 5th decade.223”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [223] Pentinga, 1993, Late onset atrioventricular nodal tachycardia, Int J Cardiol source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    There is very little evidence on anticoagulation indications for patients with atypical right atrial flutter/macroreentrant tachycardia, but associated heart disease could increase embolic risk, making anticoagulation a reasonable alternative.

    “There is very little evidence regarding indications for anticoagulation in patients with atypical FL/ MRT of the RA, but the associated heart disease could make embolic risk higher, making anticoagulation, as proposed above, a reasonable alternative.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Most accessory pathways conduct in both directions (about 60%); some conduct in only one direction; anterograde-only conduction is uncommon (<5%), while retrograde-only conduction is more frequent (17-37%).

    “although the majority of APs conduct both anterogradely and retrogradely ( 60%), some of them are able of propagating impulses in only one direction.Those that conduct in the anterograde direction only are uncommon (,5%), whereas those that conduct in the retrograde direction only are more frequent (17-37%).303”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [303] Issa, 2012, Atrioventricular reentrant tachycardia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The AV node is a three-dimensional structure with greater variability in tissue space constant and poor gap junction connectivity due to differential connexin isoform expression, conditions that explain dual conduction and nodal reentrant arrhythmogenesis.

    “The AV node is a three-dimensional structure with greater variability in the space constant of tissue, and poor gap junction connectivity due to differential expression of connexin isoforms, conditions that provide an explanation of dual conduction and nodal reentrant arrhythmogenesis.218,219”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [218] Nikolaidou, 2012, Structure-function relationship in the sinus and atrioventricular nodes, Pediatr Cardiol source

      Not checked in the free run.

    • cites [219] Hucker, 2008, Connexin 43 expression delineates two discrete pathways in the human atrioventricular junction, Anat Rec (Hoboken) source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the general population, the prevalence of the WPW pattern on surface ECG is 0.15%-0.25%, rising to 0.55% among first-degree relatives of affected patients.

    “In the general population, the prevalence of WPW pattern on surface ECG is from 0.15% to 0.25%, 304 increasing to 0.55% among first-degree relatives of affected patients.305”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [304] Krahn, 1992, The natural history of electrocardiographic preexcitation in men. The Manitoba Follow-up Study, Ann Intern Med source

      Not checked in the free run.

    • cites [305] Vidaillet, 1987, Familial occurrence of accessory atrioventricular pathways (preexcitation syndrome), N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In early studies, predictors of ventricular fibrillation in WPW syndrome were an R-R interval during spontaneous or induced AF below 180 ms, a history of symptomatic tachycardia, inducibility of AVRT, and multiple accessory pathways.

    “In early studies, identified predictors of ventricular fibrillation in patients with WPW syndrome were R-R interval during spontaneous or induced AF , 180 ms, history of symptomatic tachycardia and inducibility of AVRT, and multiple accessory pathways.308,309”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [308] Beckman, 1990, The predictive value of electrophysiologic studies in untreated patients with Wolff-Parkinson-White syndrome, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [309] Montoya, 1991, Ventricular fibrillation in the Wolff-Parkinson-White syndrome, Eur Heart J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Type II atrial flutter is likely related to functional reentrant rhythms induced by rapid pacing under acetylcholine in dogs, and in most cases is probably a laboratory, pacing-induced artifact of little clinical significance.

    “Type II AFL is likely related to the functional reentrant rhythms induced by rapid pacing under acetylcholine in the dog, and in most cases is probably a laboratory, pacing-induced artefact of little clinical significance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Heterogeneity of both fast and slow conduction patterns has been well described, and all forms of AVNRT may display anterior, posterior, middle, or even left atrial retrograde activation patterns.

    “Heterogeneity of both fast and slow conduction patterns has been well described, and all forms of AVNRT may display anterior, posterior and middle or even left atrial retrograde activation patterns.228”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [228] Katritsis, 2010, Atrioventricular nodal reentrant tachycardia, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Tachycardia inducibility at the end of the procedure does not predict long-term occurrence of macroreentrant tachycardia, and most tachycardias appearing in the first 6 to 8 weeks of follow-up resolve with antiarrhythmic drugs.

    “Tachycardia inducibility at the end of the procedure is not predictive of the long-term occurrence of MRT, and most of tachycardias appearing in the initial 6-8 weeks of follow-up disappear under AAD.158,193”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [158] Daoud, 2006, Proarrhythmia of circumferential left atrial lesions for management of atrial fibrillation, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [193] Chugh, 2005, Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation, Heart Rhythm source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The superior transseptal surgical approach to mitral valve repair or replacement is more arrhythmogenic than direct posterior left atrial atriotomy, leading to macroreentrant tachycardia circuits involving both atria that are difficult to eliminate by ablation.

    “The superior transseptal surgical approach to mitral valve repair or replacement is more arrhythmogenic than direct posterior LA atriotomy, leading to the appearance of MRT circuits involving both atria, and that are difficult to eliminate by ablation.160,200”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [160] Coffey, 2013, Catheter ablation of scar-related atypical atrial flutter, Europace source

      Not checked in the free run.

    • cites [200] Lukac, 2006, The superior transseptal surgical approach to mitral valve creates slow conduction, Pacing Clin Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A posteroseptal location of accessory pathways was found in almost all patients with VF, whereas the rate of multiple accessory pathways was similar in patients with or without VF.

    “A posteroseptal location of accessory pathways was found in almost all patients with VF, whereas the rate of multiple accessory pathways was similar in patients with or without VF, as reported by other investigators.335”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [335] Timmermans, 1995, Aborted sudden death in the Wolff-Parkinson-White syndrome, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In that registry, benign arrhythmias including AVRT and AF developed in 15.6%, while 21.6% of older patients (median age 42 years) lost ventricular preexcitation and remained asymptomatic.

    “Benign arrhythmias including AVRT and AF developed in 15.6%, while 21.6% of older patients (median age, 42 years) lost ventricular preexcitation remaining asymptomatic.322”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [322] Pappone, 2014, Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the latest meta-analysis, AVRT carried a mortality rate of 0.1% after radiofrequency ablation, while there was no procedural-related mortality for AFL or AVNRT.

    “Although these rates are higher than most experienced electrophysiologists have in daily practice, in the latest meta-analysis AVRT still carried a mortality rate of 0.1% after radiofrequency ablation, whereas there was no procedural-related mortality for AFL or AVNRT.244”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [244] Spector, 2009, Meta-analysis of ablation of atrial flutter and supraventricular tachycardia, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Asymptomatic patients who developed VF had short accessory pathway anterograde ERP less than 200-220 ms, and a shorter pre-excited RR interval during AF (SPERRI) less than 200-230 ms.

    “Asymptomatic patients who developed VF had short accessory pathway anterograde ERP less than 200 -220 ms, and a shorter pre-excited RR interval during AF (SPERRI) less than 200 -230 ms.339,341”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [339] Pappone, 2003, Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern: results from a large prospective long-term follow-up study, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [341] Santinelli, 2009, Asymptomatic ventricular preexcitation: a long-term prospective follow-up study of 293 adult patients, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In that first trial, 5-year Kaplan-Meier estimates of arrhythmic events were 7% after ablation and 77% in controls (P<0.001), with a risk reduction of 92% (RR 0.08; 95% CI 0.02-0.33; P<0.001).

    “The 5-year Kaplan -Meier estimates of the incidence of arrhythmic events were 7% among patients who underwent ablation, and 77% among the controls (P , 0.001 by the log-rank test); the risk reduction with ablation was 92% (relative risk, 0.08; 95% CI, 0.02 to 0.33; P , 0.001).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [343] Pappone, 2003, A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Concealed pathways are more frequently localized along the left free wall (64%), and less frequently at septal (31%) and right free wall locations.

    “Concealed pathways are more frequently localized along the left free wall (64%), and less frequently at septal (31%) and right free wall locations.327”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [327] Kuck, 1990, Sites of conduction block in accessory atrioventricular pathways. Basis for concealed accessory pathways, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a recent review, data from observational studies on 833 patients who did not undergo ablation showed that up to 9% developed malignant arrhythmias, and up to 2% developed VF during follow-up.

    “In a recent review, data from observational studies on 833 patients who did not undergo ablation showed that up to 9% of patients developed malignant arrhythmias, and up to 2% developed VF during follow-up.344”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [344] Al-Khatib, 2016, Risk stratification for arrhythmic events in patients with asymptomatic pre-excitation: a systematic review for the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In that second study, during follow-up, 1 child in the ablation group (5%) and 12 in the control group (44%) had arrhythmic events; two control children had VF and one died suddenly.

    “During follow-up, 1 child in the ablation group (5%), and 12 in the control group (44%) had arrhythmic events.Two children in the control group had ventricular fibrillation, and one died suddenly.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [345] Pappone, 2004, Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In an 8-year prospective study on 2169 symptomatic or asymptomatic WPW patients, those who developed VF showed more inducible pre-excited sustained AF triggered by AVRT (73.3% vs 44.9%) and shorter median accessory pathway ERP (220 vs 240 ms) than subjects without ventricular arrhythmias.

    “In an 8-year prospective study on 2169 symptomatic or asymptomatic WPW patients, electrophysiologic testing revealed that patients who developed VF, showed more inducible pre-excited sustained AF triggered by AV reciprocating tachycardia (73.3% vs. 44.9%),and shorter median accessory pathway ERP (220 vs. 240 ms) than subjects not experiencing ventricular arrhythmias.322”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [322] Pappone, 2014, Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In that first trial, EP study complications developed in 3 patients (1%) (2 pneumothorax and 1 large femoral haematoma), and an ablation-related complication (permanent RBBB) developed in 1 (3%) of 37 patients.

    “Complications related to EP study developed in three patients (1%) (2 pneumothorax and 1 large femoral haematoma).An ablation-related complication (permanent RBBB) developed in 1 (3%) of 37 patients.343”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [343] Pappone, 2003, A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the second randomized study of asymptomatic children (age 5-12) with WPW and inducible AVRT or AF, after randomization of 60 children, parents withdrew 13; of the remaining, 20 underwent prophylactic ablation and 27 had no treatment.

    “The second randomized study was conducted on asymptomatic children (age range, 5 to 12 years) with WPW syndrome and in whom AVRT or AF were reproducibly inducible.After randomization of 60 children, but before any ablation had been performed, the parents withdrew 13 of them from the study.Of the remaining children, 20 underwent prophylactic ablation and 27 had no treatment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [345] Pappone, 2004, Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mahaim conduction is usually antegrade only, but concealed fibres have also been described.

    “Mahaim conduction is usually antegrade only, but concealed fibres have also been described.332”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [332] Hluchy, 1999, Radiofrequency ablation of a concealed nodoventricular Mahaim fiber guided by a discrete potential, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    No gender predilection was found for concealed accessory pathways, and they tend to occur more frequently in younger patients than in those with AVNRT, with significant overlap.

    “Moreover, no gender predilection was found and these pathways tend to occur more frequently in younger patients than in those with AVNRT; however significant overlap exists.303”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [303] Issa, 2012, Atrioventricular reentrant tachycardia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a large retrospective series of 690 WPW patients, 15 (2.2%) had aborted sudden death, and in 8 of them (>50%) VF was the first clinical manifestation of the syndrome.

    “In a large retrospective series of 690 WPW patients, 15 (2.2%) had aborted sudden death, and in 8 of them (.50%) VF was the first clinical manifestation of the syndrome.335”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [335] Timmermans, 1995, Aborted sudden death in the Wolff-Parkinson-White syndrome, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The 2015 ACC/AHA/HRS guideline reports major complication rates after radiofrequency catheter ablation of 3.0% for AVNRT and 2.8% for AVRT.

    “The 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia report major complication rates after radiofrequency catheter ablation of 3.0% and 2.8% for AVNRT and AVRT, respectively.2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Page, 2016, 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Small trials have reported safety and efficacy of Class Ic antiarrhythmic drugs with beta blockers in WPW syndrome, but no randomized trials in this setting have been performed.

    “Small trials have reported the safety and efficacy of this drug therapy in the context of WPW syndrome, 323,324 but no randomized trials in this setting have been performed.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [323] Breithardt, 1984, Effect of propafenone in the Wolff-Parkinson-White syndrome: electrophysiologic findings and long-term follow-up, Am J Cardiol source

      Not checked in the free run.

    • cites [324] Vassiliadis, 1990, Propafenone in the prevention of non-ventricular arrhythmias associated with the Wolff-Parkinson-White syndrome, Int J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    PJRT is a rare form of atrioventricular reciprocating tachycardia using a concealed accessory pathway, usually located in the posteroseptal region, with retrograde decremental conduction properties.

    “Permanent Junctional Reciprocating Tachycardia (PJRT) represents a rare form of atrioventricular reciprocating tachycardia using a concealed accessory pathway, usually located in the posteroseptal region, with retrograde decremental conduction properties.328”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [328] Kang, 2014, Permanent junctional reciprocating tachycardia in children: a multicenter experience, Heart Rhythm source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mahaim fibers are nodoventricular or atriofascicular decrementally conducting connections between the right atrium or AV node and the right ventricle in or close to the right bundle branch.

    “Mahaim fibers are nodoventricular (as initially described) or atriofascicular (more often) decrementally conducting connections between the right atrium or the AV node and the right ventricle in or close to the right bundle branch.329 -332”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [329] Kottkamp, 1996, Variants of preexcitation--specialized atriofascicular pathways, nodofascicular pathways, and fasciculoventricular pathways: electrophysiologic findings and target sites for radiofrequency catheter ablation, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [330] Gandhavadi, 2013, Characterization of the distal insertion of atriofascicular accessory pathways and mechanisms of QRS patterns in atriofascicular antidromic tachycardia, Heart Rhythm source

      Not checked in the free run.

    • cites [331] Haissaguerre, 1995, Characteristics of the ventricular insertion sites of accessory pathways with anterograde decremental conduction properties, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In that second study, the cumulative rate of arrhythmic events was lower among high-risk children who underwent ablation than among those who did not, and the reduction remained significant after adjustment in a Cox regression analysis.

    “The cumulative rate of arrhythmic events was lower among children at high risk who underwent ablation than among those at high risk who did not.The reduction in risk associated with ablation remained significant after adjustment in a Cox regression analysis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [345] Pappone, 2004, Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In recent years, trans-baffle access has been described, and was successful in 96% of 74 attempted cases and does not seem to be associated with a higher incidence of adverse events.

    “In recent years, trans-baffle access has been described, and was successful in 96% of 74 attempted cases and does not seem to be associated with a higher incidence of adverse events.361”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [361] Correa, 2013, Transbaffle mapping and ablation for atrial tachycardias after mustard, senning, or Fontan operations, J Am Heart Assoc source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Incisional related AFL is common (20%) as is sustained VT (11%) and risk of SCD (8%).

    “Incisional related AFL is common (20%) as is sustained VT (11%) and risk of SCD (8%).387,388”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [387] Gatzoulis, 2000, Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study, Lancet source

      Not checked in the free run.

    • cites [388] Biviano, 2010, Atrial flutter catheter ablation in adult patients with repaired tetralogy of Fallot: mechanisms and outcomes of percutaneous catheter ablation in a consecutive series, J Interv Card Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The acute success rates of catheter ablation procedures of SVT in ACHD patients range from 65 to 100%, with a higher recurrence rate, 20-60% within 2 years, than seen in other cohorts for routine SVT ablation.

    “The acute success rates of catheter ablation procedures of SVT in ACHD patients ranges from 65 to 100%, with a higher recurrence rate, 20 -60% within 2 years, than seen in other cohorts for routine SVT ablation.362 -364,379”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [362] de Groot, 2010, Long-term outcome after ablative therapy of postoperative atrial tachyarrhythmia in patients with congenital heart disease and characteristics of atrial tachyarrhythmia recurrences, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

    • cites [363] Yap, 2010, Outcome of intra-atrial re-entrant tachycardia catheter ablation in adults with congenital heart disease: negative impact of age and complex atrial surgery, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [364] Wu, 2013, Acute and long-term outcome after catheter ablation of supraventricular tachycardia in patients after the Mustard or Senning operation for D-transposition of the great arteries, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In that second study, respiratory arrest and femoral vein thrombosis were seen in two patients, while ablation-related complications were seen in three patients (RBBB, transient AV block and pericardial effusion).

    “Respiratory arrest and femoral vein thrombosis were seen in two patients, while ablation-related complications were seen in three patients (RBBB, transient AV block and pericardial effusion).345”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [345] Pappone, 2004, Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Atrial tachycardias and impaired ventricular function are important and consistent risk factors for SCD in CHD; corrected Tetralogy of Fallot, post-atrial switch Mustard or Senning, left heart obstructed lesions and univentricular hearts have the highest (2-9% per decade) risk of SCD.

    “Atrial tachycardias and impaired ventricular function are important and consistent risk factors for SCD in patients with CHD, of which corrected Tetralogy of Fallot, post-atrial switch operation Mustard or Senning, left heart obstructed lesions and univentricular hearts have the highest (2 -9% per decade) risk of SCD.352 -354”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [352] Koyak, 2012, Sudden cardiac death in adult congenital heart disease, Circulation source

      Not checked in the free run.

    • cites [353] Nieminen, 2007, Causes of late deaths after pediatric cardiac surgery: a population-based study, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [354] Gallego, 2012, Incidence and predictors of sudden cardiac arrest in adults with congenital heart defects repaired before adult life, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with repaired ASD, both CTI-dependent and 'incisional' AFL can occur and coexist in the same patient.

    “In patients with repaired ASD, both CTI-dependent and 'incisional' AFL can occur and coexist in the same patient.349”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [349] Wasmer, 2013, Isthmus-dependent right atrial flutter as the leading cause of atrial tachycardias after surgical atrial septal defect repair, Int J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Long-term outcomes after secundum ASD closure using transcatheter closure and surgical closure are excellent without significant differences with regard to atrial arrhythmias (9.3%), survival, or thromboembolism.

    “Long-term outcomes after secundum ASD closure using transcatheter closure and surgical closure are excellent without significant differences with regard to atrial arrhythmias (9.3%), survival, or thromboembolism.382”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [382] Kutty, 2012, Long-term (5- to 20-year) outcomes after transcatheter or surgical treatment of hemodynamically significant isolated secundum atrial septal defect, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In that second study, independent predictors of arrhythmic events were the absence of prophylactic ablation and the presence of multiple accessory pathways.

    “In both ablation and control groups, the independent predictors of arrhythmic events were the absence of prophylactic ablation and the presence of multiple accessory pathways.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [345] Pappone, 2004, Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Incisional-related AFL or IART are the most common type of SVT (75%) in ACHD patients, and occur most frequently in patients with Ebstein anomaly, Tetralogy of Fallot, single-ventricle, Fontan procedures, TGA, and atrial septal defects.

    “These incisional-related AFL or intra-atrial re-entrant tachycardia (IART) are the most common type of SVT (75%) in adult congenital heart disease (ACHD) patients, and occur most frequently in patients with Ebstein anomaly, Tetralogy of Fallot, single-ventricle, Fontan procedures, transposition of the great arteries (TGA), and atrial septal defects.349,350”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [349] Wasmer, 2013, Isthmus-dependent right atrial flutter as the leading cause of atrial tachycardias after surgical atrial septal defect repair, Int J Cardiol source

      Not checked in the free run.

    • cites [350] Khairy, 2010, Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Even though the incidence of SCD is low (0.09% per year) in the CHD population, it is higher than in age-matched controls, and related to arrhythmias in 14% of all deaths after initial repair.

    “Even though the incidence of SCD is low (0.09% per year) in the CHD population, it is higher than in age-matched controls, 351 and related to arrhythmias in 14% of all deaths after initial repair.352,353”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [351] Silka, 1998, A population-based prospective evaluation of risk of sudden cardiac death after operation for common congenital heart defects, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [352] Koyak, 2012, Sudden cardiac death in adult congenital heart disease, Circulation source

      Not checked in the free run.

    • cites [353] Nieminen, 2007, Causes of late deaths after pediatric cardiac surgery: a population-based study, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although Class III AADs such as sotalol and amiodarone were most effective, adverse effects were common (22%).

    “Although Class III AADs such as sotalol and amiodarone were most effective, adverse effects were common (22%).368”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [368] Koyak, 2013, Efficacy of antiarrhythmic drugs in adults with congenital heart disease and supraventricular tachycardias, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Arrhythmia surgery can be integrated into a surgical repair with high efficacy and without evidence of increased surgical morbidity.

    “Arrhythmia surgery can be integrated into a surgical repair with high efficacy and without evidence of increased surgical morbidity.372”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [372] Mavroudis, 2008, Arrhythmia surgery in patients with and without congenital heart disease, Ann Thorac Surg source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Catheter ablation of IART and AVNRT in patients following Mustard or Senning operation for d-TGA has a high primary success rate albeit high 30% recurrence rates for IART but excellent long-term results after a second ablation.

    “Catheter ablation of IART and AVNRT in patients following Mustard or Senning operation for d-TGA has a high primary success rate albeit high 30% recurrence rates for IART but excellent longterm results after a second ablation.364”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [364] Wu, 2013, Acute and long-term outcome after catheter ablation of supraventricular tachycardia in patients after the Mustard or Senning operation for D-transposition of the great arteries, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Atrial flutters are drug-refractory and/or severely symptomatic in more than half of patients, and the CTI-dependent mechanism underlies approximately half of sustained, symptomatic AFLs.

    “The atrial flutters are drug-refractory and/or severely symptomatic in more than half of the patients, and the CTI-dependent mechanism underlies approximately half of the sustained, symptomatic AFLs.388”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [388] Biviano, 2010, Atrial flutter catheter ablation in adult patients with repaired tetralogy of Fallot: mechanisms and outcomes of percutaneous catheter ablation in a consecutive series, J Interv Card Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Significant ASDs in adults can be closed even later in life with consequent improved morbidity and survival, although new or recurrent ATs are frequent.

    “However, significant ASDs in adults can be closed even later in life with consequent improved morbidity and survival, 359 albeit new or recurrent ATs are frequent.360”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [359] Konstantinides, 1995, A comparison of surgical and medical therapy for atrial septal defect in adults, N Engl J Med source

      Not checked in the free run.

    • cites [360] Murphy, 1990, Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Ebstein's anomaly, accessory pathways are frequent (15-30%), more often right sided and multiple than in other patients.

    “In Ebstein's anomaly, accessory pathways are frequent (15 -30%) more often right sided and multiple than in other patients, 383 and other SVTs that can occur include AF, AFL and focal AT.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [383] Wei, 2014, Features of accessory pathways in adult Ebstein's anomaly, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ablation of CTI-dependent flutter results in high acute success rates, 96%, depending on the type of anomaly, although the recurrence rate after 45±15 months follow-up is 18%.

    “Ablation of CTI-dependent flutter results in high acute success rates, 96%, depending on the type of anomaly although the recurrence rate after 45 + 15 months follow-up is 18%.380”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [380] Dallaglio, 2016, Impact of previous cardiac surgery on long-term outcome of cavotricuspid isthmus-dependent atrial flutter ablation, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although amiodarone is less often associated with proarrhythmia, its severe side effects (thyroid and pulmonary disorders) limit its long-term use in ACHD patients.

    “Although amiodarone is less often associated with proarrhythmia, the severe side effects (thyroid and pulmonary disorders) limit its long-term use in these patients.368”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [368] Koyak, 2013, Efficacy of antiarrhythmic drugs in adults with congenital heart disease and supraventricular tachycardias, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Atrial incisions in childhood with subsequent myocardial scarring result in development of macroreentrant AT, and there is also an increased risk of pump failure, stroke and SCD.

    “The atrial incisions in childhood with subsequent myocardial scarring, however, result in the development of macroreentrant AT, and there is also an increased risk of pump failure, stroke and SCD.348”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [348] Engelfriet, 2005, The spectrum of adult congenital heart disease in Europe: morbidity and mortality in a 5 year follow-up period. The Euro Heart Survey on adult congenital heart disease, Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Atrial flutter or AF can develop in up to 42% of patients, whereas the most common atrial tachyarrhythmia is an incision-related (incisional) atrial tachycardia (66%).

    “Atrial flutter or AF can develop in up to 42% of patients, whereas the most common atrial tachyarrhythmia is an incision-related (incisional) atrial tachycardia (66%).393”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [393] Quinton, 2015, Prevalence of atrial tachyarrhythmia in adults after Fontan operation, Heart source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pharmacokinetics of antiarrhythmic drugs change during different stages of pregnancy, including changes in gastrointestinal absorption, increased blood volume, lower protein binding with increased free fraction, and increased renal and hepatic elimination.

    “These includes changes in gastrointestinal absorption, an increased blood volume, a lower binding to proteins with an increased free fraction of drug, and an increased renal and hepatic elimination.411”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [411] Mitani, 1987, The pharmacokinetics of antiarrhythmic agents in pregnancy and lactation, Clin Pharmacokinet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Right bundle branch block is present during sinus rhythm in the majority of patients, and may cause differential diagnostic difficulties requiring electrophysiology testing for a correct diagnosis.

    “Right bundle branch block is present during sinus rhythm in the majority of patients, and may cause differential diagnostic difficulties requiring electrophysiology testing for a correct diagnosis.390”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [390] Harrison, 1997, Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both Fontan and Mustard repairs have been associated with less successful ablation results as compared to other ACHD anomalies, related to low success rate (54% vs 83% for other CHD) and high recurrence rate (50% vs 32%) after an initial successful ablation procedure.

    “Both Fontan and Mustard repairs have been associated with less successful ablation results as compared to other ACHD anomalies, related not only to the low success rate of catheter ablation (54% vs. 83% for other CHD) but also to a high recurrence rate (50% vs. 32%) after an initial successful ablation procedure.363,365”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [363] Yap, 2010, Outcome of intra-atrial re-entrant tachycardia catheter ablation in adults with congenital heart disease: negative impact of age and complex atrial surgery, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [365] Yap, 2012, Evolving electroanatomic substrate and intra-atrial reentrant tachycardia late after Fontan surgery, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    The data on catheter ablation in pregnancy are based on small case series with no long-term follow-up of risk for the infant.

    “These data are however based on small case series with no long time follow-up of risk for the infant.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    The foetus may suffer from the direct haemodynamic effect of tachycardia and from adverse effects of treatment.

    “The foetus may suffer from both the direct haemodynamic effect of the tachycardia as well as adverse effects from the treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Effective treatments may have a positive impact on disease-related hospitalizations with a favourable economic profile in mid- or long-term cost-effectiveness.

    “Thus, effective treatments (interventional or pharmacological) may have a positive impact on disease-related hospitalizations, with a consequent favourable economic profile in terms of mid-or long-term cost-effectiveness.413,414”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [413] Boriani, 2013, Health technology assessment in interventional electrophysiology and device therapy: a position paper of the European Heart Rhythm Association, Eur Heart J source

      Not checked in the free run.

    • cites [414] Fattore, 2011, Health technology assessment: what is it? Current status and perspectives in the field of electrophysiology, Europace

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The ESC 2011 guidelines on pregnancy provide detailed recommendations on the safe use of antiarrhythmic drugs during pregnancy and breastfeeding.

    “Detailed recommendations on the safe use of antiarrhythmic drugs during pregnancy and breastfeeding have been provided by the ESC 2011 guidelines on pregnancy.412”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [412] Regitz-Zagrosek, 2011, ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC), Eur Heart J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Patient education can help facilitate greater patient participation in treatment decisions because informed choices require patients to understand the natural trajectory of their condition, treatment options, and likely impact on symptoms and quality of life.

    “Patient education can help to facilitate greater patient participation in treatment decisions since informed choices about therapy requires patients to understand the natural trajectory of their condition, what the treatment options are and what they can offer, and the likely impact of these treatments on their symptoms and QoL.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The proliferation of atrial fibrillation ablation will unavoidably result in more iatrogenic left atrial flutters.

    “the proliferation of AF ablation, will unavoidably result in more iatrogenic left AFLs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The perspective of a curative treatment and patient preferences have expanded the indication of ablation therapy in supraventricular tachycardia outside drug refractory arrhythmic episodes, and ablation is currently proposed as a first-line treatment option in these patients.

    “The perspective of a curative treatment and patient preferences have expanded the indication of ablation therapy in SVT outside of the setting of drug refractory arrhythmic episodes, and ablation is currently proposed as a first-line treatment option in SVT patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    This improvement is perhaps not surprising given that ablation often significantly reduces or eliminates symptoms.

    “This is perhaps not surprising given that ablation often significantly reduces or eliminates symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    These quality-of-life studies are limited by small sample sizes, highly selected populations, short follow-up periods, often lacking a suitable control group, and frequent recall and responder bias.

    “However, these studies are limited by their small sample sizes, in highly selected populations, with short follow-up periods, often lacking a suitable control group, and are frequently hampered by recall and responder bias.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Several important advances in anatomic and electrical mapping, appreciation of scar tissue, and transmurality of ablation lesions should improve efficiency in treating these patients.

    “Several and important advances in the field of anatomic and electrical mapping, as well as appreciation of scar tissue and transmurality of ablation lesions, should improve our efficiency in treating these patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Available evidence on patient experiences of supraventricular tachycardia has recently been reviewed in a European Heart Rhythm Association position document.

    “The available evidence on patient's experiences of SVT has recently been reviewed in a European Heart Rhythm Association (EHRA) position document.419”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [419] Lane, 2015, Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE), Europace source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The prolonged survival of adults with congenital heart disease is expected to impose a further challenge for adult electrophysiologists who will have to deal with even more complex atrial macroreentrant tachycardias.

    “Moreover, the prolonged survival of ACHD patients is expected to impose a further challenge for the adult electrophysiologists who will have to deal with even more complex atrial macroreentrant tachycardias.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The prolonged survival of adults with congenital heart disease is expected.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Advice and recommendations for key discussion points between physicians and patients with supraventricular tachycardia have recently been outlined in another European Heart Rhythm Association document.

    “Advice and recommendations for key discussion points between physicians and patients with SVT have recently been outlined in another EHRA document.419”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [419] Lane, 2015, Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE), Europace source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    The vision of a fully radiation-free, magnetic laboratory in the future is not science fiction anymore.

    “The vision of a fully radiation-free, magnetic laboratory in the future is not science fiction any more.427”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [427] Hilbert, 2016, Real-time magnetic resonance-guided ablation of typical right atrial flutter using a combination of active catheter tracking and passive catheter visualization in man: initial results from a consecutive patient series, Europace source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Further analysis of recorded ECGs using fast Fourier and Gaussian models might provide useful diagnostic information about the nature of the tachycardia.

    “It might be possible that further analysis of recorded ECGs using fast Fourier and Gaussian models might be able to provide useful diagnostic information about the nature of the tachycardia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    The revolution in computer technology offers improved mapping and electrode moving systems, and enhances specific supraventricular tachycardia classification schemes by fully automated algorithms that may greatly assist emergency departments, ambulances, and monitored patients.

    “The revolution in computer technology offers not only improved mapping and electrode moving systems, but also enhances specific SVT classification schemes by fully automated algorithms that may greatly assist emergency departments, ambulances, and monitored patients.428”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [428] Perlman, 2015, Supraventricular tachycardia classification in the 12-lead ECG using atrial waves detection and a clinically based tree scheme, IEEE J Biomed Health Inform

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    These developments may have important implications for a more specific diagnosis and personalized therapeutic approach in supraventricular tachycardia.

    “These developments may have important implications for a more specific diagnosis, and personalized therapeutic approach in SVT.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Coupling whole exome sequencing with cellular electrophysiologic functional analysis may elucidate the underlying pathophysiologic mechanism responsible for certain phenotypes.

    “Coupling whole exome sequencing with cellular electrophysiologic functional analysis may elucidate the underlying pathophysiologic mechanism responsible for certain phenotypes.433”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [433] Weyhrauch, 2016, Whole exome sequencing and heterologous cellular electrophysiology studies elucidate a novel loss-of-function mutation in the CACNA1A-encoded neuronal P/Q-type calcium channel in a child with congenital hypotonia and developmental delay, Pediatr Neurol source

      Not checked in the free run.

171 of 171

  • The paper relies on this without support.

    The Valsalva manoeuvre is more effective than carotid sinus massage for terminating SVT in adults.

    “The Valsalva manoeuver has generally been shown to be most effective in adults, having a superior effect on SVT termination compared to carotid sinus massage.”

  • The paper relies on this without support.

    Carotid sinus massage carries a risk of carotid atheroembolism and stroke even when no audible bruit is present.

    “It should be always unilateral, as there is a risk of carotid atheroembolism and stroke even in the absence of an audible bruit.”

  • The paper relies on this without support.

    Rapid IV adenosine can cause transient side effects including flush, bronchospasm, dyspnoea, and temporary AV block.

    “Rapid intravenous injection of adenosine may result in unpleasant but transient side effects (flush, bronchospasm, shortness of breath, temporary AV block).”

  • The paper relies on this without support.

    Theophylline may require higher adenosine doses, and dipyridamole potentiates adenosine effects.

    “Patients treated with theophylline may require higher doses of adenosine and adenosine effects are potentiated by dipyridamole.”

  • The paper relies on this without support.

    Concomitant adenosine and carbamazepine may cause higher rates of heart block.

    “In addition, higher rates of heart block may be seen when adenosine is concomitantly administered with carbamazepine.”

  • The paper relies on this without support.

    Adenosine may induce AF in 1–15% of cases, usually transient but potentially problematic in patients with ventricular pre-excitation.

    “Adenosine may also induce AF (1% to 15%), which is usually transient but may be particularly problematic in patients with ventricular pre-excitation.”

  • The paper relies on this without support.

    No randomized trials have compared DC cardioversion with IV drugs for conversion in hemodynamically compromised patients.

    “No randomized trials have been conducted comparing DC with IV drugs for conversion in this situation.”

  • The paper relies on this without support.

    Catheter ablation for IST has limited efficacy, with long-term clinical success ranging from 23% to 83%.

    “This approach has limited efficacy, with a very modest long-term clinical success ranging from 23 to 83%.”

  • The paper relies on this without support.

    Medical treatment of sinus node reentrant tachycardia is empirical, and no drugs have been studied in controlled trials.

    “Therapy Medical treatment is empirical, and no drugs have been studied in controlled trials.”

  • The paper relies on this without support.

    The three putative mechanisms of focal AT are automaticity, triggered activity, and microreentry.

    “The three putative mechanisms of focal AT are automaticity, triggered activity, and microreentry.”

  • The paper relies on this without support.

    Adenosine usually has no impact on macro-reentries, although termination has been rarely reported.

    “Usually, adenosine has no impact on macro-reentries, although termination has been rarely reported.”

  • The paper relies on this without support.

    DC cardioversion is usually effective in acutely terminating AT irrespective of mechanism.

    “Direct current (DC) cardioversion is usually effective in acutely terminating the tachycardia, irrespective of the mechanism.”

  • The paper relies on this without support.

    Reentry is very sensitive to DC shocks, and energy as low as 50 J may terminate it, a striking difference from AF.

    “However, reentry is very sensitive to DC shocks and energy as low as 50 J may terminate it, which is a striking difference when compared with AF.”

  • The paper relies on this without support.

    One-to-one AV conduction is rare in AFL; there is usually some AV block, most often 2:1 with regular ventricular rates typically 130–160/min.

    “One-to-one AV conduction is rare and there is usually a degree of AV block, most often 2:1 with regular ventricular rates typically 130 -160/min.”

  • The paper relies on this without support.

    RA dilatation is present in AFL but can be reversible after AFL interruption by CTI ablation.

    “RA dilatation is present in AFL, but it can be reversible after AFL interruption by CTI ablation.”

  • The paper relies on this without support.

    In about 90% of typical AFL cases, activation courses supero-inferiorly in the anterior and lateral RA and infero-superiorly in the septal RA.

    “In about 90% of typical AFL cases, activation courses supero-inferiorly in the anterior and lateral RA and inferosuperiorly in the septal RA.”

  • The paper relies on this without support.

    Conduction through the CTI is anterior to posterior in counterclockwise AFL.

    “Conduction through the CTI is anterior to posterior in what is often called counterclockwise AFL (Figure 11).”

  • The paper relies on this without support.

    The ECG in typical AFL shows rounded or bimodal positive deflections in inferior leads and a very characteristic bimodal negative wave in V1 shaped like a W.

    “The ECG shows rounded or bimodal positive deflections in the inferior leads and in V 1 a very characteristic bimodal negative wave in the shape of a W (Figure 11).”

  • The paper relies on this without support.

    Clockwise AFL is considered also typical (reverse typical AFL).

    “This clockwise AFL is considered also typical (reverse typical AFL).”

  • The paper relies on this without support.

    Typical AFL may be paroxysmal or persistent.

    “Typical AFL may be paroxysmal or persistent.”

  • The paper relies on this without support.

    Clinical presentation of typical AFL depends in large part on ventricular rate, which tends to be rapid in the majority of cases.

    “Its clinical presentation will depend in large part on the ventricular rate, which tends to be rapid in the majority of cases.”

  • The paper relies on this without support.

    When atrial flutter has lasted more than 48 hours, the risk of thromboembolism is increased regardless of the cardioversion technique, unless transesophageal echocardiography has excluded intra-atrial thrombi.

    “If AFL has been present for .48h, the risk of thromboembolism is higher, no matter the technique used for cardioversion, unless trans-oesophageal echocardiography has ruled out intra-atrial thrombi.”

  • The paper relies on this without support.

    In patients with both atrial fibrillation and atrial flutter, the embolic risk appears to be the same as in atrial fibrillation, and the same indications for chronic anticoagulation apply when stroke risk factors are present.

    “In patients with episodes of both AF and AFL the embolic risk appears the same as in AF and the same indications for chronic anticoagulation should be considered, in the presence of stroke risk factors.”

  • The paper relies on this without support.

    No direct evidence from randomized trials specifically in atrial flutter exists for the risk-benefit ratio of chronic anticoagulation.

    “There is no direct evidence of the risk vs. benefit ratio of chronic anticoagulation in patients with AFL, as no specific randomized trials in AFL per se have been conducted.”

  • The paper relies on this without support.

    Transthoracic electrical cardioversion is the fastest and most effective way to restore sinus rhythm.

    “Transthoracic electrical cardioversion is the quickest and most effective method to recover sinus rhythm.”

  • The paper relies on this without support.

    Atrioventricular reentrant tachycardias are the most common tachycardias associated with WPW syndrome, accounting for 80%.

    “Atrioventricular reentrant tachycardias are the most common (80%) tachycardias associated with WPW syndrome.”

  • The paper relies on this without support.

    Orthodromic AVRT accounts for 95% of AVRTs and 35% of all sustained paroxysmal SVTs.

    “Orthodromic AVRT accounts for 95% of AVRTs, and 35% of all sustained paroxysmal SVTs.”

  • The paper relies on this without support.

    Antidromic AVRT occurs in approximately 5% of patients with WPW syndrome.

    “Antidromic AVRT occurs in approximately 5% of patients with WPW syndrome.”

  • The paper relies on this without support.

    Up to 50-75% of patients with spontaneous antidromic AVRT have multiple accessory pathways.

    “Up to 50-75% of patients with spontaneous antidromic AVRT have multiple AP (manifest or concealed), which could act or not as the retrograde limb during the AVRT.”

  • The paper relies on this without support.

    Paroxysmal atrial fibrillation has been found in 50% of patients with WPW, and is the presenting arrhythmia in 20%.

    “Paroxysmal atrial fibrillation (AF) has been found in 50% of patients with WPW, and is the presenting arrhythmia in 20%.”

  • The paper relies on this without support.

    In antidromic AVRT with multiple bypass tracts, drugs acting on the AV node are ineffective.

    “In case of antidromic AVRT with multiple bypass tracts, one acting as the anterograde limb and one as the retrograde, drugs acting on the AVN are ineffective.”

  • The paper relies on this without support.

    The commonest tachycardia in patients with concealed accessory pathways is orthodromic AVRT.

    “The commonest tachycardia in patients with concealed accessory pathways is orthodromic AVRT, with a reentrant circuit using the AV node and His Purkinje system in the anterograde direction, followed by conduction through the ventricle, retrograde conduction over the concealed accessory pathway, and completion of the circuit by conduction through the atrium back into the AV node.”

  • The paper relies on this without support.

    In some cases, patients can be readily identified as having an accessory pathway with a long refractory period, and therefore very low risk of sudden death, when they demonstrate intermittent loss of pre-excitation during sinus rhythm.

    “In some cases, patients can be readily identified as having an accessory pathway that has a long refractory period, and therefore are a very low risk of sudden death, when they demonstrate intermittent loss of pre-excitation during sinus rhythm.”

  • The paper relies on this without support.

    The efficacy and safety of antiarrhythmic drugs in ACHD patients have not been evaluated in randomized clinical trials.

    “The efficacy and safety of AADs in ACHD patients have not been evaluated in randomized clinical trials (Table 19).”

  • The paper relies on this without support.

    All antiarrhythmic drugs have an increased risk of proarrhythmia, and may exacerbate sinus node dysfunction as well as heart failure, and thus require in-hospital observation.

    “All AADs have an increased risk of proarrhythmia, and may exacerbate sinus node dysfunction as well as heart failure, and thus require in-hospital observation.”

  • The paper relies on this without support.

    The majority of antiarrhythmic drugs are classified as FDA category C, meaning that risk of adverse foetal effect cannot be ruled out.

    “According to the recently abandoned FDA classification system of drugs during pregnancy, the majority of AADs are classified as category C, meaning that risk cannot be ruled out for adverse effect on the foetus”

  • The paper relies on this without support.

    None of the antiarrhythmic drugs has been proven completely safe in pregnancy.

    “and none of the AADs has been proven completely safe.”

  • The paper relies on this without support.

    The risk of teratogenic effects is highest during organogenesis, which takes place during the first 8-10 weeks of gestation.

    “The risk of teratogenic effects is highest during the organogenesis which takes place during the first 8 -10 weeks of gestation.”

  • The paper relies on this without support.

    Beta-blockers have been used extensively in pregnancy without evidence of teratogenicity.

    “Beta-blockers have been used extensively in pregnancy without evidence of teratogenicity”

  • The paper relies on this without support.

    Procainamide can cause a lupus-like syndrome with long-term use.

    “Procainamide has been used in pregnant women for acute treatment of pre-excited tachycardia but can cause lupus-like syndrome with long-term use.”

  • The paper relies on this without support.

    In experienced hands, the use of 3-D mapping systems allows completely x-ray free ablation, obviating the foetal risk of radiation.

    “In experienced hands, the use of 3-D Mapping Systems allows completely x-ray free ablation, thus obviating the foetal risk of radiation.”

  • The paper relies on this without support.

    Many arrhythmic conditions induce substantial costs.

    “As shown in cost of illness studies, many arrhythmic conditions induce substantial costs.”

  • The paper relies on this without support.

    Drug therapy for supraventricular tachycardia is characterized by continuous diluted costs, variable patient adherence, limited efficacy, and poor long-term patient satisfaction.

    “Drug therapy is characterized by continuous diluted costs, variable patient adherence (sometimes very low), limited efficacy, and poor patient satisfaction in the long-term.”

  • The paper relies on this without support.

    Atrioventricular nodal reentrant tachycardia accounts for 50% of all supraventricular tachycardia cases and is seen with the same frequency as before.

    “AVNRT that accounts for 50% of all cases is seen with the same frequency as before”

  • The paper relies on this without support.

    The prolonged survival of adults with congenital heart disease is expected.

    “Moreover, the prolonged survival of ACHD patients is expected to impose a further challenge”

  • The paper relies on this without support.

    The last decade has witnessed a rapid evolution of ablation equipment and electrode guiding systems that have resulted in more controllable and safer procedures.

    “The last decade has witnessed a rapid evolution of ablation equipment and electrode guiding systems that have resulted in more controllable and safer procedures.”

  • The paper relies on this without support.

    New materials for electrodes and other equipment have allowed the concept of a radiation-free electrophysiology laboratory with the use of MRI.

    “New materials for electrodes and other equipment have allowed the concept of radiation-free EP laboratory with the use of MRI.”

  • The paper relies on this without support.

    Supraventricular tachycardias are an everyday clinical problem, with atrioventricular nodal reentrant tachycardia being the most common regular arrhythmia in humans.

    “SVTs are not only an everyday clinical problem, with AVNRT being the most common regular arrhythmias in the human”

  • The paper relies on this without support.

    Worsening factors such as electrolytic imbalance, hyperthyroidism and anaemia occur more often during pregnancy.

    “Worsening factors, occurring more often during pregnancy, such as electrolytic imbalance, hyperthyroidism and anaemia should be evaluated”

  • The paper relies on this without support.

    Procainamide has been used in pregnant women for acute treatment of pre-excited tachycardia.

    “Procainamide has been used in pregnant women for acute treatment of pre-excited tachycardia”
50 of 50

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Authors
Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., Lane, D. A., Lip, G. Y. H., Malmborg, H., Oral, H., Pappone, C., Themistoclakis, S., Wood, K. A., Blomström-Lundqvist, C., ESC Scientific Document Group, Gorenek, B., Dagres, N., Dan, G.-A., Vos, M. A., Kudaiberdieva, G., Crijns, H., Roberts-Thomson, K., Lin, Y.-J., Vanegas, D., Caorsi, W. R., Cronin, E., & Rickard, J.
Affiliations
  • Beth Israel Deaconess Medical Center (US)
  • University of Modena and Reggio Emilia (IT)
  • Hospital Universitario De Getafe, Madrid, Spain
  • Leipzig University (DE)
  • University of Bordeaux, CHU Bordeaux, LIRYC, France
  • Berth Israel Deaconess Medical Center, Boston, MA, USA
  • Hospital Privado (AR)
  • Korea University Medical Center (KR)
  • Northwestern Memorial Hospital (US)
  • Asklepios Hospital St Georg, Hamburg, Germany
  • Birmingham City Hospital (GB)
  • Uppsala University (SE)
  • University of Michigan (US)
  • IRCCS Policlinico San Donato (IT)
  • Ospedale dell' Angelo (IT)
  • Emory University (US)
  • Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
  • Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
  • Carol Davila University of Medicine and Pharmacy (RO)
  • University Medical Center Utrecht (NL)
  • Maastricht University Medical Centre (NL)
  • Royal Adelaide Hospital (AU)
  • Royal Adelaide Hospital, Adelaide, Australia
  • Taipei Veterans General Hospital (TW)
  • Hospital Militar Central (CO)
  • Hartford Hospital (US)
  • Cleveland Clinic (US)
ORCID
Venue
Europace
Publisher
Oxford University Press (OUP)
Published
2016-11-17
Volume
19
Issue
3
Pages
465-511
ISSN
  • 1099-5129 (ISSN-L)
  • 1532-2092
DOI
10.1093/europace/euw301
OpenAlex
W3023238132
Semantic Scholar
19df754205fe5f0595ea538026f2df89ae21262c
Cited by
188
References
447
Citations by year
2026: 12 · 2025: 13 · 2024: 13 · 2023: 13 · 2022: 16 · 2021: 20 · 2020: 28 · 2019: 27 · 2018: 23 · 2017: 21 · 2016: 2
FWCI
16.69
Type
journal article
Language
en
Open access
Locations
  • EP Europace (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Keywords
supraventricular arrhythmias, atrial tachycardia, arrhythmia management, antiarrhythmic therapy, catheter ablation, cardioversion, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia
MeSH terms
Action Potentials, Cardiology, Diagnosis, Differential, Heart Rate, Humans, Predictive Value of Tests, Tachycardia, Supraventricular, Treatment Outcome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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