Atrioventricular Nodal Reentry Tachycardia (AVNRT) Follow-up

Author: Brian Olshansky, MD; Chief Editor: Jeffrey N Rottman, MD more...

Updated: Feb 28, 2012

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Further Inpatient Care
Further Outpatient Care
Inpatient & Outpatient Medications
Transfer
Deterrence/Prevention
Complications
Prognosis
Patient Education
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Further Inpatient Care

The need for further inpatient care depends on the frequency of episodes, the severity of symptoms, and the ease of termination.

If episodes are infrequent, well tolerated, and easily terminated by the patient, no prophylactic therapy is needed.
If the episodes are significantly symptomatic, frequent, and/or last long enough to necessitate therapy, radiofrequency catheter ablation or drugs may be necessary to prevent episodes (see Medical Care).
Radiofrequency catheter ablation should be considered early in the treatment of patients with symptomatic recurrent episodes, patients intolerant to drugs, patients who opt to not undergo a curative procedure, or in patients in whom drugs are ineffective.

Further Outpatient Care

See Further Inpatient Care.

Inpatient & Outpatient Medications

See Medical Care.

Transfer

Transfer to facility with electrophysiology and radiofrequency ablation may be needed for indications described in Further Inpatient Care.

Deterrence/Prevention

Prevention of further episodes is accomplished as described in Further Inpatient Care.

Complications

Complications include hemodynamic compromise, congestive heart failure, syncope, tachycardia-induced cardiomyopathy, myocardial ischemia, and myocardial infarction.

Prognosis

The prognosis is usually good in the absence of structural heart disease. Most patients respond to medications to prevent recurrence or to radiofrequency ablation, which is approximately 95% curative and has a low risk of complications. It is the preferred method of treatment for most patients.

Patient Education

Patients should be educated about vagal maneuvers to try to terminate the episode.

Patients with hemodynamic compromise or syncope should be educated about avoiding activities that could be dangerous to them or to others (eg, driving, swimming) while the risk of an episode remains. Ablation obviates the need for any long-term restriction.

For patient education resources, see the Heart Center, as well as Supraventricular Tachycardia.

Contributor Information and Disclosures

Author

Brian Olshansky, MD Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine

Brian Olshansky, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, Cardiac Electrophysiology Society, and Heart Rhythm Society

Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting

Coauthor(s)

Renee M Sullivan, MD Fellow, Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics

Renee M Sullivan, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Russell F Kelly MD, Assistant Professor, Department of Internal Medicine, Rush Medical College; Chairman of Adult Cardiology and Director of the Fellowship Program, Cook County Hospital

Russell F Kelly is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Marschall S Runge, MD, PhD Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine

Marschall S Runge, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Southern Society for Clinical Investigation, and Texas Medical Association

Disclosure: Pfizer Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Orthoclinica Diagnostica Consulting fee Consulting

Amer Suleman, MD Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD Professor of Medicine and Pharmacology, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthors Shamila Garg, MD, and Marina Hannen, MD, Chirag M Sandesara, MD, Mukesh Garg, MD, MRCP, Annette Quick, MD, and Marco A Barzallo, MD to the development and writing of this article.

References

Jackman WM, Beckman KJ, McClelland JH, et al. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med. Jul 30 1992;327(5):313-8. [Medline].
Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. 7^th ed. Philadelphia, Pa: WB Saunders; 2004.
Fogoros RN. Electrophysiologic Testing (Practical Cardiac Diagnosis). 3^rd ed. London, UK: Blackwell Science; 1999.
Gursoy S, Steurer G, Brugada J, et al. Brief report: the hemodynamic mechanism of pounding in the neck in atrioventricular nodal reentrant tachycardia. N Engl J Med. Sep 10 1992;327(11):772-4. [Medline].
Janse MJ, Anderson RH, McGuire MA, Ho SY. "AV nodal" reentry: Part I: "AV nodal" reentry revisited. J Cardiovasc Electrophysiol. Oct 1993;4(5):561-72. [Medline].

Electrophysiological mechanism of atrioventricular nodal reentry tachycardia.

Atypical atrioventricular nodal reentry tachycardia.

Typical atrioventricular nodal reentry tachycardia.

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