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Atrioventricular nodal reentrant tachycardia

Background

Overview

Definition
AVNRT is a type of SVT characterized by a reentry circuit within the atrioventricular node.
1
Pathophysiology
The pathophysiology of AVNRT involves dual pathways within the atrioventricular node, typically referred to as the fast and slow pathways. These dual pathways create a reentry circuit, leading to the abnormal electrical signals and rapid HR characteristic of this condition.
2
Epidemiology
The incidence of AVNRT in patients receiving ICDs is estimated at 3.5%.
3
Disease course
Clinically, AVNRT often presents with symptoms such as palpitations, dizziness, and shortness of breath. The duration and frequency of AVNRT episodes can vary widely among patients, with some experiencing infrequent, short-lived episodes and others suffering from more persistent or recurrent tachycardia.
4
Prognosis and risk of recurrence
The prognosis of AVNRT is generally good. It is a benign condition but can lead to significant morbidity due to the symptoms it causes.
5

Guidelines

Key sources

The following summarized guidelines for the management of atrioventricular nodal reentrant tachycardia are prepared by our editorial team based on guidelines from the European Society of Cardiology (ESC 2020) and the American Heart Association (AHA/HRS/ACC 2016). ...
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Medical management

Acute management
As per ESC 2020 guidelines:
Administer IV adenosine (6-18 mg bolus) for acute management of hemodynamically stable patients with AVNRT if vagal maneuvers fail.
B
Consider administering IV formulations of the following medications for acute management of hemodynamically stable patients with AVNRT if vagal maneuvers and adenosine fail:
nondihydropyridine CCBs, i.e. verapamil or diltiazem
β-blockers, i.e. esmolol or metoprolol
C
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  • Ongoing management

Nonpharmacologic interventions

Vagal maneuvers: as per ESC 2020 guidelines, perform vagal maneuvers, preferably in the supine position with leg elevation, for acute management of hemodynamically stable patients with AVNRT.
B

Therapeutic procedures

Synchronized electrical cardioversion
As per ESC 2020 guidelines:
Perform synchronized direct current cardioversion for acute management of hemodynamically unstable patients with AVNRT.
B
Perform synchronized direct current cardioversion for acute management of hemodynamically stable patients with AVNRT if drug therapy fails to convert or control the tachycardia.
B

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  • Catheter ablation

Follow-up and surveillance

Follow-up: as per ACC/AHA/HRS 2016 guidelines, consider obtaining clinical follow-up without pharmacological therapy or ablation for ongoing management of minimally symptomatic patients with AVNRT.
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