Supraventricular tachycardia AHA recommendations for Management of Orthodromic AVRT
Supraventricular tachycardia Microchapters |
Differentiating Among the Different Types of Supraventricular Tachycardia |
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Differentiating Supraventricular Tachycardia from Ventricular Tachycardia |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
Management of Orthodromic AVRT
Acute Treatment of Orthodromic AVRT
Class I |
"1. Vagal maneuvers are recommended for acute treatment in patients with orthodromic AVRT "(Level of Evidence: B-R) " |
"2. Adenosine is beneficial for acute treatment in patients with orthodromic AVRT "(Level of Evidence: B-R) " |
"3. Synchronized cardioversion should be performed for acute treatment in hemodynamically unstable patients with
AVRT if vagal maneuvers or adenosine are ineffective or not feasible "(Level of Evidence: B-NR) " |
"4. Synchronized cardioversion is recommended for acute treatment in hemodynamically stable patients with AVRT
when pharmacological therapy is ineffective or contraindicated "(Level of Evidence: B-NR) " |
"5. Synchronized cardioversion should be performed for acute treatment in hemodynamically unstable patients with
pre-excited AF"(Level of Evidence: B-NR ) " |
"6. Ibutilide or intravenous procainamide is beneficial for acute treatment in patients with pre-excited AF
who are hemodynamically stable "(Level of Evidence: C-LD) " |
Class IIa |
"1. Intravenous diltiazem, verapamil "(Level of Evidence: B-R) or beta blockers can be effective for acute treatment in patients with orthodromic AVRT who do not have preexcitation
on their resting ECG during sinus rhythm "(Level of Evidence: C-LD) " |
Class IIb |
"1. Intravenous beta blockers, diltiazem, or verapamil might be considered for acute treatment in patients with orthodromic
AVRT who have pre-excitation on their resting ECG and have not responded to other therapies"(Level of Evidence:B-R) " |
Class III(harm) |
"1. Intravenous digoxin, intravenous amiodarone, intravenous or oral beta blockers, diltiazem, and verapamil are
potentially harmful for acute treatment in patients with pre-excited AF ( "(Level of Evidence: C-LD) " |
Management of ongoing Orthodromic AVRT
Class I |
"1.Catheter ablation of the accessory pathway is recommended in patients with AVRT and/or pre-excited AF"(Level of Evidence: B-NR) " |
"2.Oral beta blockers, diltiazem, or verapamil are indicated for ongoing management of AVRT in patients without
pre-excitation on their resting ECG "(Level of Evidence: C-LD) " |
Class IIa |
"1.Oral flecainide or propafenone is reasonable for ongoing management in patients without structural heart disease or ischemic heart disease who have AVRT and/or pre-excited AF and are not candidates for, or prefer not to undergo, catheter ablation"(Level of Evidence: C-LD) " |
Class IIb |
"1.Oral dofetilide or sotalol may be reasonable for ongoing management in patients with AVRT and/or pre-excited
AF who are not candidates for, or prefer not to undergo, catheter ablation"(Level of Evidence:B-R) " |
"2.Oral amiodarone may be considered for ongoing management in patients with AVRT and/or pre-excited AF who are not candidates for, or prefer not to undergo, catheter ablation and in whom beta blockers, diltiazem, flecainide, propafenone, and verapamil are ineffective or contraindicated"(Level of Evidence:C-LD) " |