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Antidromic atrioventricular reentrant tachycardia

Background

Overview

Definition
Antidromic atrioventricular reentrant tachycardia is a type of SVT where the electrical impulses in the heart travel in an abnormal, reverse direction, leading to a rapid HR.
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Pathophysiology
The pathophysiology of antidromic atrioventricular reentrant tachycardia involves an abnormal accessory pathway in the heart that allows electrical impulses to bypass the normal conduction system. This creates a reentrant circuit, leading to rapid HRs. In some cases, the bypass tract serves as the anterograde limb of the circuit and the atrioventricular node as the retrograde limb of the reentrant circuit.
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Epidemiology
Antidromic atrioventricular reentrant tachycardia is a rare condition with an estimated incidence of 8% in patients with pre-excitation syndrome.
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Disease course
Clinically, patients with antidromic atrioventricular reentrant tachycardia may present with symptoms such as palpitations, dizziness, and shortness of breath. However, in some cases, patients may be asymptomatic.
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Prognosis and risk of recurrence
The prognosis of antidromic atrioventricular reentrant tachycardia is generally benign, but it can lead to severe complications in rare instances.
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Guidelines

Key sources

The following summarized guidelines for the management of antidromic atrioventricular reentrant tachycardia are prepared by our editorial team based on guidelines from the European Society of Cardiology (ESC 2020). ...
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Medical management

Acute management
As per ESC 2020 guidelines:
Consider administer IV formulations of the following medications for acute management of hemodynamically stable patients with antidromic atrioventricular reentrant tachycardia if vagal maneuvers and adenosine fail:
ibutilide
procainamide
flecainide
profanenone
C
Consider administering IV amiodarone for acute management of hemodynamically stable patients with refractory antidromic atrioventricular reentrant tachycardia.
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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 antidromic atrioventricular reentrant tachycardia.
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Therapeutic procedures

Synchronized electrical cardioversion: as per ESC 2020 guidelines, perform synchronized direct current cardioversion for acute management of hemodynamically unstable patients with antidromic atrioventricular reentrant tachycardia.
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  • Catheter ablation