Atrioventricular Node Reentry Supraventricular Tachycardia Guidelines

Updated: Dec 09, 2020
  • Author: Glenn T Wetzel, MD, PhD; Chief Editor: Stuart Berger, MD  more...
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Guidelines

Guidelines Summary

In 2015, the American College of Cardiology, American Heart Association, and the Heart Rhythm Society (ACC/AHA/HRS) released joint guidelines for the management of supraventricular tachycardia that includes specific recommendations for both acure and ongoing managment of atrioventicular node reentry tachycardia (AVNRT). [21]

Management of Acute AVNRT

Vagal maneuvers and/or IV adenosine are the recommended initial treatments for acute AVNRT. (Class I; level of evidence B-R)

Additional recommendations for acute treatment when adenosine and vagal maneuvers are ineffective or contraindicated are summarized below.

Hemodynamically unstable patients

  • Synchronized cardioversion (class I; level of evidence B-NR)

Hemodynamically stable patients

  • Synchronized cardioversion when beta blockers, diltiazem, or verapamil are ineffective or contraindicated (class I; level of evidence B-NR)
  • IV beta blockers, diltiazem, or verapamil (class IIa; level of evidence: B-R)
  • Oral beta blockers, diltiazem, or verapamil may be considered (class IIb; level of evidence: C-LD)
  • IV amiodarone may be considered when other therapies are ineffective or contraindicated (class IIb; level of evidence: C-LD)

The guidelines note that for rhythms that break or recur spontaneously, synchronized cardioversion is not appropriate. 

Management of Ongoing AVNRT

Minimally symptomatic

Clinical follow-up without pharmacologic therapy or ablation is reasonable for minimally symptomatic patients with AVNRT. (Class IIa; level of evidence B-R)

Self-administered (“pill-in-the-pocket”) acute doses of oral beta blockers, diltiazem, or verapamil may be reasonable for patients with infrequent, well-tolerated episodes of AVNRT. (Class IIb; level of evidence C-LD)

Symtomatic 

Catheter ablation of the slow pathway is the recommended initial treatment for ongoing management of symptomatic AVNRT. (Class I; level of evidence B-R) Patients who are not candidates for, or prefer not to undergo, catheter ablation should be treated with verapamil, diltiazem, or oral beta blockers. (Class I; level of evidence B-R) 

Additional treatment options for ongoing treatment of AVNRT include:

  • ​Flecainide or propafenone in patients without structural heart disease or ischemic heart disease when Class I  therapies (catheter ablation; beta blockers, diltiazem, or verapamil) are ineffective or contraindicated. (Class IIa; level of evidence B-R)
  • Oral sotalol, dofetilide, oral digoxin, or amiodarone may be reasonable for patients who are not candidates for, or prefer not to, undergo catheter ablation. (Class IIb; level of evidence B-R)