Atrioventricular Nodal Reentry Tachycardia Medication

Updated: Nov 19, 2019
  • Author: Brian Olshansky, MD, FESC, FAHA, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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Medication

Medication Summary

Drugs used to terminate an acute episode of atrioventricular nodal reentry tachycardia (AVNRT) are given intravenously. These medications include the following:

  • Adenosine (first line)

  • Calcium channel blockers (eg, diltiazem, verapamil)

  • Beta-blockers (eg, esmolol, propranolol, metoprolol, atenolol)

  • Digitalis

Drugs used to prevent recurrences are given orally and include calcium channel blockers, long-acting beta-blockers, and digitalis.

As previously mentioned, the administration of adenosine or other AV nodal blocking agents may, in rare cases, lead to ventricular fibrillation or even asystole for a short time period.

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Cardiovascular, Other

Class Summary

Antiarrhythmic drugs affect the electrophysiology of the pathways responsible for AVNRT.

Adenosine (Adenocard)

Adenosine transiently blocks conduction through the AV node. It can interrupt reentry pathways through the AV node and restore normal sinus rhythm in paroxysmal SVT, including paroxysmal SVT associated with Wolff-Parkinson-White (WPW) syndrome. Adenosine has a short half-life. It is the preferred medication for IV administration to terminate AVNRT because of its rapid metabolism and generally good safety profile.

Digoxin (Lanoxin)

Cardiac glycosides have direct and indirect inotropic effects on the cardiovascular system. Digoxin acts directly on cardiac muscle, increasing myocardial systolic contractions. Indirect actions result in increased vagal activity for any given increase in mean arterial pressure. Digoxin is administered intravenously to terminate an acute attack, but it has a delayed onset of action and is less effective than other therapies. The drug is given orally to prevent recurrence. IV digoxin has generally been supplanted by other medications.

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Calcium Channel Blockers

Class Summary

These drugs block the AV nodal pathways responsible for AVNRT (particularly, the slow pathway).

Diltiazem (Dilacor XR, Tiazac, Cartia XT, Cardizem)

It is administered intravenously to terminate an acute attack, and orally to prevent recurrence.

Verapamil (Calan, Covera-HS, Verelan)

This is the second-line treatment for AVNRT after adenosine. Verapamil causes fewer adverse effects, is less expensive, and lasts longer; however, its action is not as rapid, and hypotension, bradycardia, and a negative inotropic effect may occur. The drug is good to use in lieu of adenosine if AVNRT recurs after termination.

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Beta-Blockers, Beta-1 Selective

Class Summary

These agents are used for AV nodal blockade.

Esmolol (Brevibloc)

Esmolol's short half-life of 8 minutes allows for titration to the desired effect and quick discontinuation if necessary.

Atenolol (Tenormin)

Atenolol selectively blocks beta-1 receptors, with little or no effect on beta-2 types. Atenolol is 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.

Metoprolol (Lopressor, Toprol XL)

Metoprolol is a selective beta-1 adrenergic receptor blocker that decreases the automaticity of contractions. During intravenous administration, carefully monitor blood pressure, heart rate, and ECG.

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