Supraventricular tachycardia AHA recommendations for Management of Orthodromic AVRT
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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 orthodromic AVRT. Catheter ablation of the accessory pathway on their resting ECG is recommended in patients with AVRT and/or pre-excited AF. Oral beta blockers, diltiazem, or verapamil are indicated for ongoing management of AVRT in patients without pre-excitation on their resting ECG.[1]
Management of Orthodromic AVRT
2015 AHA recommendations for the management of the acute and ongoing treatment for the orthodromic AVRT are described below:[1]
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 flecainideor 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) " |
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.