Atrioventricular Nodal Reentry Tachycardia (AVNRT) Medication
- Author: Brian Olshansky, MD; Chief Editor: Jeffrey N Rottman, MD more...
Medication Summary
Drugs used to terminate an acute episode are given intravenously and include adenosine (first-line), calcium channel blockers (eg, diltiazem, verapamil), beta-blockers (eg, esmolol, propranolol, metoprolol, atenolol), and digitalis.
Drugs used to prevent recurrences are given orally and include calcium channel blockers, long-acting beta-blockers, and digitalis.
Antiarrhythmics
Class Summary
Alter the electrophysiologic mechanisms responsible for arrhythmia. Most commonly used agents work by slowing conduction at the AV node.
Adenosine (Adenocard)
Transiently slows or blocks conduction time through AV node. Can interrupt reentry pathways through AV node and restore normal sinus rhythm in paroxysmal SVT, including PSVT associated with WPW syndrome. Has a short half-life. Adenosine is the preferred medication for IV administration to terminate AVNRT because of its rapid metabolism and generally good safety profile.
Cardiac glycosides
Class Summary
These agents are used for AV nodal blockade.
Digoxin (Lanoxin)
Cardiac glycosides have direct and indirect inotropic effects on the cardiovascular system. Acts directly on cardiac muscle, increasing myocardial systolic contractions. Indirect actions result in increased vagal activity for any given increase in mean arterial pressure. Administered IV to terminate an acute attack (but delayed onset of action and less effective than other therapies) and PO to prevent recurrence. Generally IV digoxin has been supplanted by other medications.
Calcium channel blockers (nondihydropyridine)
Class Summary
These agents are used for AV nodal blockade.
Diltiazem (Dilacor, Tiamate, Cardizem)
During depolarization, inhibits calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium. Administered IV to terminate an acute attack and PO to prevent recurrence.
Verapamil (Calan, Covera-HS, Verelan)
By interrupting reentry at AV node, can restore normal sinus rhythm in patients with paroxysmal SVTs. This is the second-line treatment for AVNRT after emergent adenosine. Causes fewer adverse effects, is less expensive, and lasts longer, but action is not as rapid and hypotension, bradycardia, and a negative inotropic effect may occur; good to use in lieu of adenosine if AVNRT recurs after termination
Beta-adrenergic blockers
Class Summary
These agents are used for AV nodal blockade.
Esmolol (Brevibloc)
Excellent for use in patients at risk for experiencing complications from beta-blockade (particularly those with reactive airway disease, mild-to-moderate LV dysfunction, and/or peripheral vascular disease). Short half-life of 8 min allows for titration to desired effect and quick discontinuation if needed.
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. 7th ed. Philadelphia, Pa: WB Saunders; 2004.
Fogoros RN. Electrophysiologic Testing (Practical Cardiac Diagnosis). 3rd 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].
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