2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia
Authors: Richard L. Page, José A. Joglar, Mary A. Caldwell, Hugh Calkins, Jamie B. Conti, Barbara J. Deal, N.A. Mark Estes, Michael E. Field, Zachary D. Goldberger, Stephen C. Hammill, Julia H. Indik, Bruce D. Lindsay, Brian Olshansky, Andrea M. Russo, Win-Kuang Shen, Cynthia M. Tracy, Sana M. Al-Khatib
Journal: Circulation (2015)

comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion.Only selected references are cited.The Task Force recognizes the need for objective, independent Evidence Review Committees (ERCs) that include methodologists, epidemiologists, clinicians, and biostatisticians who systematically survey, abstract, and assess the evidence to address key clinical questions posed in the PICOTS format (P=population, I=intervention, C=comparator, O=outcome, T=timing, S=setting). 4,5 Practical considerations, including time and resource constraints, limit the ERCs to evidence that is relevant to key clinical questions and lends itself to systematic review and analysis that could affect the strength of corresponding recommendations.Recommendations developed by the GWC on the basis of the systematic review are marked " SR ". Guideline-Directed Medical TherapyThe term guideline-directed medical therapy refers to care defined mainly by ACC/AHA Class I recommendations.For these and all recommended drug treatment regimens, the reader should confirm dosage with product insert material and carefully evaluate for contraindications and interactions.Recommendations are limited to treatments, drugs, and devices approved for clinical use in the United States. Class of Recommendation and Level of EvidenceThe Class of Recommendation (COR; ie, the strength of the recommendation) encompasses the anticipated magnitude and certainty of benefit in proportion to risk.The Level of Evidence (LOE) rates evidence supporting the effect of the intervention on the basis of the type, quality, quantity, and consistency of data from clinical trials and other reports (Table 1). 5,7 Unless otherwise stated, recommendations are sequenced by COR and then by LOE.Where comparative data exist, preferred strategies take precedence.When >1 drug, strategy, or therapy exists within the same COR and LOE and no comparative data are available, options are listed alphabetically.Each recommendation is followed by supplemental text linked to supporting references and evidence tables. Relationships With Industry and Other EntitiesThe ACC and AHA sponsor the guidelines without commercial support, and members volunteer their time.The Task Force zealously avoids actual, potential, or perceived conflicts of interest that might arise through relationships with industry or other entities (RWI).All GWC members and reviewers are required to disclose current industry relationships or personal interests from 12 months before initiation of the writing effort.Management of RWI involves selecting a balanced GWC and assuring that the chair and a majority of committee members have no relevant RWI (Appendix 1).Members are restricted with regard to writing or voting on sections to which their RWI apply.For transparency, members' comprehensive disclosure information is available online.Comprehensive disclosure information for the Task Force is also available online.The Task Force strives to avoid bias by selecting experts from a broad array of backgrounds representing different geographic regions, sexes, ethnicities, intellectual perspectives/biases, and scopes of clinical practice, and by inviting organizations and professional societies with related interests and expertise to participate as partners or collaborators. Individualizing Care in Patients With Associated Conditions and ComorbiditiesManaging patients with multiple conditions can be complex, especially when recommendations applicable to coexisting illnesses are discordant or interacting. 8 The guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances.The recommendations should not replace clinical judgment. Clinical ImplementationManagement in accordance with guideline recommendations is effective only when followed.Adherence to recommendations can be enhanced by shared decision making between clinicians and patients, with patient engagement in selecting interventions based on individual values, preferences, and associated conditions and comorbidities.Consequently, circumstances may arise in which deviations from these guidelines are appropriate.