Atrioventricular Node Reentry Supraventricular Tachycardia Medication

Updated: Jan 25, 2022
  • Author: Glenn T Wetzel, MD, PhD; Chief Editor: Stuart Berger, MD  more...
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Medication

Medication Summary

Emergency treatment in the patient with hemodynamic instability is directed at immediate synchronized cardioversion. If the patient is stable, then the goal is to convert the rhythm to sinus through a brief episode of atrioventricular (AV) block. Adenosine is the drug of choice for acute termination of AV nodal reentrant tachycardia (AVNRT). [59] Esmolol, other beta-adrenergic blockers, verapamil, and digoxin also have been used with some success.

Drugs used for long-term therapy that have some effect in AV node reentrant tachycardia include digoxin, beta-blockers, and verapamil. [60] Avoid intravenous verapamil use in infants because of its negative inotropic effects and avoid its use in combination with beta-blockers.

Digoxin has been used in cases of fetal supraventricular tachycardia (SVT) and atrial flutter (AF). However, it is sometimes ineffective, especially in cases of fetal hydrops. A retrospective review of pregnancies with fetal tachycardia at one center found sotalol, alone or combined with digoxin, to be an effective alternative treatment for fetal SVT and AF. [61]

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Antiarrhythmic agents

Class Summary

These agents alter the electrophysiologic mechanisms responsible for arrhythmia.

Adenosine (Adenocard)

Slows conduction time through AV node. Can interrupt reentry pathways through AV node and restore normal sinus rhythm in PSVT.

Esmolol (Brevibloc)

Excellent drug 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. A loading dose is described to speed up the onset of effect but can be deferred, particularly if there is a concern for a poor hemodynamic response to acute beta blockade.

Digoxin (Lanoxin, Lanoxicaps)

Cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. Acts directly on cardiac muscle, increasing myocardial systolic contractions. Its indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure. Generally not an effective acute treatment for AVNRT since the vagotonic effect is centrally mediated and so is delayed by several hours by the blood-brain barrier.

Propranolol (Inderal)

Class II antiarrhythmic nonselective beta-adrenergic receptor blocker with membrane-stabilizing activity that decreases automaticity of contractions.

Atenolol (Tenormin)

Selectively blocks beta1-receptors with little or no effect on beta2 types. The advantage is the requirement of administration only twice per day in young infants. Causes less central nervous system effects than propranolol because atenolol does not cross the blood brain barrier.

Verapamil (Calan)

Acts on the slow calcium current in SA and AV nodal cells. Decreases the rate of phase 4 automaticity and phase 0 depolarization, prolonging refractoriness and conduction time. Interrupts AVNRT by slowing conduction through the AV node.

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