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Orthodromic atrioventricular reentrant tachycardia

Key sources
The following summarized guidelines for the management of orthodromic atrioventricular 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).
1
2

Guidelines

1.Medical management

Acute management
Administer intravenous adenosine (8-18 mg bolus) for acute management of hemodynamically stable patients with orthodromic atrioventricular reentrant tachycardia if vagal maneuvers fail.
B
Consider administering IV formulations of the following medications for acute management of hemodynamically stable patients with orthodromic atrioventricular reentrant tachycardia if vagal maneuvers and adenosine fail:
nondihydropyridine CCBs, i.e. verapamil or diltiazem
C
β-blockers, i.e. esmolol or metoprolol in the absence of decompensated HF.
C
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  • Ongoing management

2.Nonpharmacologic interventions

Vagal maneuvers: perform vagal maneuvers, preferably in the supine position with leg elevation, for acute management of hemodynamically stable patients with orthodromic atrioventricular reentrant tachycardia.
B

3.Therapeutic procedures

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

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  • Catheter ablation