Supraventricular tachycardia AHA recommendations for Management of AVNRT
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Supraventricular tachycardia Microchapters |
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Differentiating Among the Different Types of Supraventricular Tachycardia |
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Differentiating Supraventricular Tachycardia from Ventricular Tachycardia |
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2015 ACC/AHA Guideline Recommendations |
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Directions to Hospitals Treating Supraventricular tachycardia |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
Vagal maneuvers, adenosine, and synchronized cardioversion are recommended for acute treatment in patients with AVNRT. Intravenous amiodarone may be considered for acute treatment in hemodynamically stable patients with AVNRT when other therapies are ineffective or contraindicated. Catheter ablation of the slow pathway is recommended in patients with AVNRT. Oral verapamil or diltiazem is recommended for ongoing management in patients with AVNRT who are not candidates for, or prefer not to undergo, catheter ablation.[1]
Management of AVNRT
2015 AHA recommendations for the management of acute and ongoing AVNRT are described below:[1]
Acute treatment of AVNRT
| Class I |
| "1. Vagal maneuvers are recommended for acute treatment in patients with AVNRT "(Level of Evidence:B-R) " |
| "2. Adenosine is recommended for acute treatment in patients with AVNRT "(Level of Evidence:B-R ) " |
| "3. Synchronized cardioversion should be performed for acute treatment in hemodynamically unstable patients with AVNRT when adenosine and vagal maneuvers do not terminate the tachycardia or are not feasible"(Level of Evidence: B-NR) " |
| "4. Synchronized cardioversion is recommended for acute treatment in hemodynamically stable patients with AVNRT when pharmacological therapy does not terminate the tachycardia or is contraindicated"(Level of Evidence: B-NR) " |
| Class IIa |
| "1. Intravenous beta blockers, diltiazem, or verapamil are reasonable for acute treatment in hemodynamically stable patients with AVNRT"(Level of Evidence: B-R) " |
| Class IIb |
| "1. Oral beta blockers, diltiazem, or verapamil may be reasonable for acute treatment in hemodynamically stable patients with AVNRT "(Level of Evidence:C-LD) " |
Management of ongoing AVNRT
| Class I |
| "1. Oral verapamil or diltiazem is recommended for ongoing management in patients with AVNRT who are not candidates for, or prefer not to undergo, catheter ablation "(Level of Evidence:B-R) " |
| "2. Catheter ablation of the slow pathway is recommended in patients with AVNRT "(Level of Evidence:B-NR ) " |
| "3. Oral beta blockers are recommended for ongoing management in patients with AVNRT who are not candidates for, or prefer not to undergo, catheter ablation"(Level of Evidence: B-R) " |
| Class IIa |
| "1. Flecainide or propafenone is reasonable for ongoing management in patients without structural heart disease or ischemic heart disease who have AVNRT and are not candidates for, or prefer not to undergo, catheter ablation and in whom beta blockers, diltiazem, or verapamil are ineffective or contraindicated"(Level of Evidence: B-R) " |
| "2. Clinical follow-up without pharmacological therapy or ablation is reasonable for ongoing management in minimally symptomatic patients with AVNRT"(Level of Evidence: B-NR) " |
| Class IIb |
| "1. Oral sotalol or dofetilide may be reasonable for ongoing management in patients with AVNRT who are not candidates for, or prefer not to undergo, catheter ablation "(Level of Evidence:B-R) " |
| "2. Oral digoxin or amiodarone may be reasonable for ongoing treatment of AVNRT in patients who are not candidates for, or prefer not to undergo, catheter ablation( "(Level of B-R ) " |
| "3. Self-administered (“pill-in-the-pocket”) acute doses of oral beta blockers, diltiazem, or verapamil may be reasonable for ongoing management in patients with infrequent, well-tolerated episodes of AVNRT( "(Level of C-LD) " |
References
- ↑ 1.0 1.1 Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ; et al. (2016). "2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society". J Am Coll Cardiol. 67 (13): e27–e115. doi:10.1016/j.jacc.2015.08.856. PMID 26409259.