Materiały źródłowe

• #1 Atrioventricular nodal reentry tachycardia (AVNRT) – Overview – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/avnrt/cdc-20355254

  Atrioventricular nodal reentry tachycardia (AVNRT) is a type of irregular heartbeat, also called an arrhythmia. It is the most common type of supraventricular tachycardia. […] AVNRT may not need treatment. When recommended, treatment may include specific actions or movements, medicines, or a heart procedure. […] Most people with atrioventricular nodal reentry tachycardia (AVNRT) don’t need treatment. But if the fast heartbeat occurs often or lasts a long time, treatment may be needed. Treatment for AVNRT may include: […] Vagal maneuvers. Simple but specific actions such as coughing, bearing down as if having a bowel movement, gently massaging the main artery in the neck or putting an ice pack on the face can help slow down the heart rate. […] Cardioversion. Paddles or patches on the chest are used to electrically shock the heart and help reset the heart rhythm. Cardioversion is typically used when vagal maneuvers and medicines don’t work.

• #1 Typical atrioventricular nodal reentrant and orthodromic atrioven

  https://www.openaccessjournals.com/articles/typical-atrioventricular-nodal-reentrant-and-orthodromic-atrioventricular-tachycardias-electrocardiographic-electrophysiological-d.html

  Symptoms include palpitations, fatigue, chest pain, light-headedness, neck discomfort, polyuria and presyncope and syncope. […] The hypothesis of nodal reentry has been postulated by Mines in 1913. […] The refractory period of the slow pathway is shorter in women, resulting in a greater difference between the fast and slow pathway refractory periods. […] To reversal to sinus rhythm, vagal maneuver can succeed when made at the beginning of tachycardia. […] One of the vagal maneuvers is the carotid sinus massage. […] If these first-line interventions are not effective, the pharmacological treatment should be done with the intravenous administration of adenosine (class I) or calcium channel blocker of the phenylalkylamine. […] Adenosine is a nucleotide with negative chronotropic and dromotropic properties with short half-life of about 10 seconds.

• #1 AVNRT: AV Nodal Reentrant Tachycardia – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/avnrt-av-nodal-reentrant-tachycardia/

  AVNRT Management […] A hemodynamically stable patient who is experiencing an acute episode of AVNRT should be treated with vagal maneuvers such as carotid sinus massage or Valsalva maneuver to achieve reconversion to sinus rhythm. However, carotid sinus massage should be avoided or used with extreme caution in older adults and patients at risk of stroke. […] Patients for whom vagal maneuvers are not effective may need pharmacotherapy. The first-line medication for acute episodes of AVNRT is intravenous adenosine 6 to 12 mg. If treatment with adenosine is inappropriate or unsuccessful, other intravenous medication options include: […] – A calcium channel blocker (such as verapamil or diltiazem); or […] – A beta blocker (such as metoprolol or esmolol). […] Electrical cardioversion should be used for a patient experiencing an acute episode of AVNRT who is not hemodynamically stable or for whom other treatments are not effective.

• #1 Atrioventricular Nodal Reentry Tachycardia Treatment & Management: Approach Considerations, Pharmacologic Therapy, Radiofrequency Catheter Ablation

  https://emedicine.medscape.com/article/160215-treatment

  Drugs that can be used to terminate an attack include adenosine, calcium channel blockers (eg, diltiazem, verapamil), beta-blockers, and digitalis. […] Adenosine is the first-line drug used for termination of atrioventricular nodal reentry tachycardia (AVNRT). […] Intravenous verapamil 5-10 mg is effective to stop AVNRT and it may be better tolerated in some individuals than adenosine. […] Intravenous diltiazem can be effective to terminate AV nodal reentry supraventricular tachycardia but, in our experience, it is not recommended as the primary approach to stop AVNRT. […] Preventive therapy is needed for frequent, prolonged, or highly symptomatic episodes that do not terminate spontaneously or for those that cannot be easily terminated by the patient. […] Radiofrequency catheter ablation of the reentrant circuit should be considered in patients who have frequent or highly symptomatic episodes, who do not want drug therapy, who cannot tolerate the drugs, or in whom drug therapy fails.

• #1

  https://step2.medbullets.com/evidence/29239759

  Atrioventricular-nodal-reentry tachycardia (AVNRT) is a form of supraventricular tachycardia (SVT) that is relatively common in the emergency department (ED). It is rarely indicative of underlying electrical or structural pathology. […] This review evaluates the literature and controversies concerning treatment of AVNRT in the ED. […] For treatment of narrow-complex tachycardia, Advanced Cardiovascular Life Support guidelines recommend the use of vagal maneuvers, followed by adenosine. Recent literature suggests that nondihydropyridine calcium channel blockers, such as verapamil and diltiazem, may be as effective as adenosine, without the negative short-term side effects. Multiple studies have demonstrated that although adenosine is rapid acting, there is no statistically significant difference in conversion rate between adenosine and calcium channel blockers. Both medications result in a conversion rate above 90%, but there are significantly more minor adverse effects, such as flushing or chest discomfort, with adenosine. Calcium channel blockers are a viable option for treatment for AVNRT, especially in refractory states. Beta-blockers have been evaluated but should not be used routinely due to lower efficacy. AVNRT is the most common tachydysrhythmia in pregnancy, and vagal maneuvers and adenosine are first line. Electrical cardioversion should be utilized for hemodynamically unstable patients. Most patients with AVNRT may be discharged with appropriate follow-up. […] Several studies demonstrate that nondihydropyridine calcium channels (verapamil and diltiazem) are equally as efficacious as adenosine in converting AVNRT to sinus rhythm, without the negative (albeit short-lived) side effects. If given over 20 min, the risk for hypotension is low.

• #1

  https://journals.lww.com/cardiovascularpharm/abstract/1991/00176/antiarrhythmic_treatment_of_atrioventricular.8.aspx

  Prevention of AVNRT episodes can be obtained with various antiarrhythmic drugs. Digoxin alone or in combination with -blockers is effective in 50% of the cases and especially when the combination proved to be successful during electrophysiological testing. Oral calcium antagonists are successful in 4090% of the patients, and class IA agents (quinidine or procainamide) abolish the inducibility of the tachycardia in 6070% of patients. Class IC (propafenone and flecainide) have proven effective in controlling AVNRT in 7080% of the patients. Amiodarone also seems to be effective in treating patients with AVNRT but may cause serious side effects and should be used in this indication only as a last resort. […] The choice of the treatment depends on the clinical presentation of the arrhythmia, on the patient, and on the electrophysiological characteristics of the accessory pathway.

• #1 Atrioventricular Nodal Reentrant Tachycardia – Core EM

  https://coreem.net/core/avnrt/

  AVNRT is a common tachydysrhythmia that results from a reentrant loop within the AV node. […] Unstable patients with AVNRT should be considered for immediate synchronized electrical cardioversion. […] Stable patients with AVNRT can have a trial of vagal maneuvers followed by chemical cardioversion with adenosine or verapamil and synchronized electrical cardioversion if that fails. […] The primary goal is to convert the patient back to sinus rhythm. […] If the patient is unstable, proceed directly to electrical cardioversion. […] If the patient is stable, you may pursue non-pharmacological therapy with vagal maneuvers, electrical cardioversion or chemical cardioversion. […] Synchronized cardioversion is indicated for unstable patients with AVNRT. […] Synchronized cardioversion can also be strongly considered in stable patients with AVNRT.

• #1 Atrioventricular nodal reentry tachycardia (AVNRT) – Overview – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/avnrt/cdc-20355254

  Medicines. If the fast heartbeat happens frequently, your healthcare professional may prescribe medicines to slow or control your heart rate. […] Catheter ablation. This treatment may be suggested if medicines don’t work or if their side effects are too bothersome. A doctor inserts thin, flexible tubes called catheters through the veins or arteries, usually in the groin. Sensors on the tip of the catheter use heat or cold energy to create tiny scars in the heart. The scars block irregular electrical signals and restore a typical heartbeat.

• #1 AV Nodal Reentrant Tachycardia (AVNRT)

  http://www.washingtonhra.com/arrhythmias/av-nodal-reentrant-tachycardia-avnrt.php

  AV nodal reentrant tachycardia, AVNRT, is the most common cause of supraventricular tachycardia (SVT). […] Therapy for patients suffering from AVNRT depends on the frequency and severity of symptoms. Your physician may decide to implement therapy with oral medications if you are having frequent episodes that affect your daily living. […] MedicationMedications used to terminate symptomatic AVNRT episodes and to reduce AVNRT occurrences include beta-blockers, calcium channel blockers, and less commonly digoxin. […] For those patients who elect to forgo medication either due to intolerable symptoms or side effects from their medications, recurrent symptoms and episodes despite medical therapy, or lack of desire to take daily medications for an extended period of time, your physician may recommend you undergo an electrophysiology study (EPS) and possible curative catheter ablation.

• #1 Atrioventricular Nodal Reentrant Tachycardia | Thoracic Key

  https://thoracickey.com/atrioventricular-nodal-reentrant-tachycardia-3/

  Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia. […] Maintenance of AVNRT is dependent on AVN conduction; hence, maneuvers or drugs that slow AVN conduction and prolong AVN refractoriness are used to terminate the tachycardia. For chronic management of AVNRT, pharmacological therapy and catheter ablation can be considered. Long-term pharmacological therapy (including beta blockers and calcium channel blockers) can be effective in 30% to 60% of patients. On the other hand, catheter ablation is associated with higher efficacy (95%) and low incidence of complications and therefore has become the preferred initial therapeutic approach. The slow pathway is the target of ablation for all variants of AVNRT. […] Once it is decided to initiate treatment for AVNRT, the question arises whether to initiate pharmacological therapy or to use catheter ablation. Because of its high efficacy (95%) and low incidence of complications, catheter ablation has become the preferred therapy over long-term pharmacological therapy and can be offered as an initial therapeutic option.

• #1 Atrioventricular nodal reentry tachycardia (AVNRT) // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/atrioventricular-nodal-reentry-tachycardia-avnrt

  Catheter ablation. This treatment may be suggested if medicines don’t work or if their side effects are too bothersome. A doctor inserts a thin, flexible tube called a catheter through a blood vessel, usually in the groin, and guides it to the heart. Sensors on the tip of the catheter use heat or cold energy to create tiny scars in the heart. The scars block irregular electrical signals and restore a typical heartbeat.

• #1 Diagnosis and treatment of atrioventricular nodal reentrant tachycardia: a case report illustrating clinical management and ablation strategy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7501927/

  Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular arrhythmia that is frequently encountered in an otherwise healthy patient population. Recent guidelines of the European Society of Cardiology underline the role of catheter ablation in the long-term management of these patients. […] Catheter ablation should be considered as an initial treatment choice in symptomatic patients with AVNRT, given the high success rate and low risk for complications. […] In patients with recurrent symptomatic episodes of AVNRT, there is a good and clear indication for catheter ablation, which can be performed with a high success rate (97%) and a very low risk of complications. […] The risk of periprocedural AV block can be minimized by avoiding ablation near the His-bundle and compact AV node. Rather than moving the ablation catheter higher up to the mid-septum if slow pathway conduction cannot be eliminated from the right posteroseptal area, a left-sided approach is recommended to eliminate slow pathway conduction by targeting the leftward inferior extension of the AV node.

• #1 Atrioventricular Nodal Reentrant Tachycardia: Current Perspectives | RRCC

  https://www.dovepress.com/atrioventricular-nodal-reentrant-tachycardia-current-perspectives-peer-reviewed-fulltext-article-RRCC

  Radiofrequency catheter ablation (RFCA) of the slow pathway is, at present, the first choice treatment for AVNRT, presenting high acute success and long-term efficacy. […] An alternative energy source is cryoablation, which was mainly developed to overcome the risk of permanent AV block that can potentially occur with RFCA. […] The aim of this review is to summarize current evidence on AVNRT treatment, focusing on catheter ablation, and in particular on the differences and similarities between RFCA and cryoablation. […] Current guidelines propose catheter ablation as a class I indication and pharmacological treatment as a class IIa alternative, considering patients preference and the clinical opportunities of both approaches. […] Catheter ablation of AVNRT targets the slow pathway, which is activated anterogradely in the typical form of AVNRT.

• #1 Atrioventricular Nodal Reentry Tachycardia Treatment & Management: Approach Considerations, Pharmacologic Therapy, Radiofrequency Catheter Ablation

  https://emedicine.medscape.com/article/160215-treatment

  Radiofrequency catheter ablation is associated with cure rates of greater than 95%, with very low risk of atrioventricular (AV) block (1%) for patients with AV nodal reentry tachycardia (AVNRT). […] Cryoablation has been increasingly used for treating AVNRT, with reported safety and efficacy, including in children.

• #1 Diagnosis and treatment of atrioventricular nodal reentrant tachycardia: a case report illustrating clinical management and ablation strategy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7501927/

  While radiofrequency energy is used most commonly as energy source for ablation of AVNRT, cryoablation may carry a lower risk for AV block and therefore is sometimes preferred for ablation in children, although studies have demonstrated a higher risk of recurrence when compared with radiofrequency catheter ablation.

• #1 Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia | AER Journal

  https://www.aerjournal.com/articles/classification-electrophysiological-features-and-therapy-atrioventricular-nodal-reentrant?language_content_entity=en

  Atrioventricular nodal reentrant tachycardia (AVNRT) should be classified as typical or atypical. […] When the diagnosis of AVNRT is established, ablation should be only directed towards the anatomic position of the slow pathway. If right septal attempts are unsuccessful, the left septal side should be tried. […] Catheter ablation is the current treatment of choice. Slow pathway ablation or modification is effective in both typical and atypical AVNRT. […] Ablation should be only directed towards the anatomic position of the slow pathway. If right septal attempts are unsuccessful, the left septal side should be tried. […] This approach offers a success rate of 95 %, is associated with a risk of 0.51 % AV block and has approximately 4 % recurrence rate. There is no mortality associated with this procedure.

• #1 What Is Atrioventricular Nodal Reentry Tachycardia (AVNRT)? – Rytmedoktor

  https://rytmedoktor.dk/en/what-is-atrioventricular-nodal-reentry-tachycardia-avnr/

  AVNRT is an abbreviation for the painfully long condition called: “AtrioVentricular Nodal Reentry Tachycardia” (we’ll stick to AVNRT!). […] You can give medicine for AVNRT, most often of the beta-block or calcium-block type. In many cases, however, I would recommend an ablation treatment as an alternative to long-term medical treatment. By ablation for AVNRT, some impulse conducting fibers are heated near the AV node. It causes healing in more than 95%. […] Although the ablation is performed within the vicinity of the AV-node, the risk for damaging the impulse conduction from the atria and down into the heart chambers is well below 1%. […] Ablation is typically performed under local anesthesia and the operation takes less than an hour. […] AVNRT is an absolutely benign heart rhythm disturbance without any prognostic significance. Therefore, it is solely the symptom burden that should affect decisions on ablation or not.

• #1 Atrioventricular Nodal Reentrant Tachycardia: Current Perspectives | RRCC

  https://www.dovepress.com/atrioventricular-nodal-reentrant-tachycardia-current-perspectives-peer-reviewed-fulltext-article-RRCC

  Historically, RFCA is the gold standard for AVNRT ablation, presenting a very high acute success and long-term efficacy, consistently over 95% in most of the published series. […] However, it is still associated with a risk of permanent complete AV block (up to 1%). […] Cryoablation, on the other hand, is an effective and safe alternative to RFCA, with no permanent AV block reported in the larger studies, and a comparably excellent acute success rate. […] The treatment of AVNRT relies on both pharmacological and interventional approaches, but during recent years catheter ablation, by both RFCA and cryoenergy, has emerged as the first choice treatment, being highly effective and safe.

• #1 Electrophysiology Study and Ablation of Atrioventricular Nodal Reentrant Tachycardia (Ablation) – MD Searchlight

  https://mdsearchlight.com/therapeutics/electrophysiology-study-and-ablation-of-atrioventricular-nodal-reentrant-tachycardia-ablation/

  The necessary team for performing a catheter ablation, a procedure to correct heart rhythm problems, includes: a certified electrophysiologist (a doctor who specializes in hearts electrical activity), a first assistant, a cardiac nurse (a nurse who specializes in heart care), and an electrophysiology technician or specially trained electrophysiology nurse. […] To prepare for an Electrophysiology Study and Ablation of Atrioventricular Nodal Reentrant Tachycardia, the patient should not eat or drink for at least six hours before the procedure. […] The complications of Electrophysiology Study and Ablation of Atrioventricular Nodal Reentrant Tachycardia include AV block, which may require the implantation of a pacemaker, problems accessing the blood vessels, puncturing the heart, leakage of fluid into the heart sack causing compression (tamponade), bleeding, the formation of a dangerous clot (thromboembolic events), and a low risk of death (0.1%) and other negative events (2.9%). […] The success rate of this treatment over a long time is high. There’s a very low chance (as little as 1.5%) of the condition coming back, as shown by several studies.

• #1 Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia | AER Journal

  https://www.aerjournal.com/articles/classification-electrophysiological-features-and-therapy-atrioventricular-nodal-reentrant?language_content_entity=en

  Advanced age is not a contraindication for slow pathway ablation. […] The preexistence of first-degree heart block may carry a higher risk for late AV block and slow pathway modification, as opposed to complete elimination, is probably preferable in this setting. […] Cryoablation may carry a lower risk of AV block, but it is negligible and this mode of therapy is associated with a significantly higher recurrence rate.

• #1 Ablation of atrioventricular nodal re-entrant tachycardia is safe and effective in the elderly | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2011.36

  Ablation of atrioventricular nodal re-entrant tachycardia is safe and effective in the elderly. […] Catheter ablation for atrioventricular nodal re-entrant tachycardia (AVNRT) is no exception. […] Boris Hoffmann and colleagues have now reported that ablation can be performed for AVNRT in patients aged 75 years with equal safety and efficacy as in younger patients. […] the investigators concluded that because antiarrhythmic drug therapy is often ineffective in this age group [75 years], catheter ablation of AVNRT should be considered the preferred treatment option, even in elderly patients.

• #1 Clinical and Experimental Pediatrics

  https://www.e-cep.org/m/journal/view.php?number=20125550691

  Atrioventricular nodal reentry tachycardia (AVNRT) is less common in pediatric patients than in adult patients. […] We aimed to analyze the patient characteristics, treatment, and any recurrences in pediatric AVNRT patients. […] RFCA was performed using the anatomic approach under fluoroscopic guidance. […] RFCA is safe and effective in pediatric AVNRT patients. However, further research is needed for establishing the endpoints of ablation in pediatric AVNRT patients and for identifying risk factors by evaluating data on AVNRT recurrence after RFCA. […] This study evaluated the efficacy of RFCA by retrospectively analyzing data on pediatric AVNRT patients who underwent RFCA at a single regional center. […] The success rate of RFCA in pediatric AVNRT cases reported by the Pediatric Radiofrequency Catheter Ablation Registry and the Pediatric Electrophysiology Society was 95%, which was similar to that noted in adults.

• #1 AV nodal reentrant tachycardia (AVNRT) – Paces

  https://www.pacesep.org/patient-resources/avnrt/

  Your EP team may prescribe medication for treatment. Medication is not a cure but can decrease the number of episodes and help to control symptoms. In most cases, these medications are taken daily. […] An EP Study and ablation is a curative procedure for SVT. […] The vagus nerve is a nerve in the body that can affect the heart rate. When it is stimulated, the heart rate can slow down. Certain maneuvers, called vagal maneuvers, are designed to stop the SVT by stimulating the vagus nerve. […] If the episode is lasts a long time, your child is ill or has fainted or you don’t feel comfortable doing these maneuvers at home, you can call your doctor or go to an emergency room. If your child appears very ill, you should call 911. In the emergency room, your child may receive an intravenous (IV) medication to stop the SVT. If the medication is not successful and your child remains ill, a brief electrical shock (cardioversion), may be required. This is usually done while your child is sedated.

• #1 Diagnosis and Management of Common Types of Supraventricular Tachycardia | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1101/p793.html

  AVNRT is the most common type of SVT in adults. […] Catheter ablation is an effective first-line treatment option for many patients with AVRT or AVNRT. […] Catheter ablation is the standard of care for older children with symptomatic SVT, although pharmacologic therapy remains the treatment of choice for newborns and infants. […] Catheter ablation has a success rate of 95%, with a recurrence rate of less than 5% and a rate of inadvertent heart block of less than 1%. […] Patients with Wolff-Parkinson-White syndrome cannot receive nodal-blocking medications in the long-term because of the risk of ventricular fibrillation; therefore, symptomatic patients should receive catheter ablation.

• #1 Atrioventricular nodal reentrant tachycardia – UpToDate

  https://www.uptodate.com/contents/atrioventricular-nodal-reentrant-tachycardia

  Atrioventricular nodal reentrant tachycardia (AVNRT) is a regular supraventricular tachycardia (SVT) that results from the formation of a reentry circuit confined to the AV node and perinodal atrial tissue. […] This topic will review the mechanisms, clinical manifestations, diagnosis, and management of AVNRT. […] Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of regular, sustained, paroxysmal supraventricular tachycardia (PSVT), accounting for nearly two-thirds of all PSVTs, and is more common in female patients. […] AVNRT usually occurs in patients with otherwise normal hearts; however, it can occur in patients with structural heart disease. […] Atrioventricular nodal reentrant tachycardia (AVNRT) generally requires the existence of dual electrical pathways in the AV node.

• #1 AVNRT: AV Nodal Reentrant Tachycardia – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/avnrt-av-nodal-reentrant-tachycardia/

  Patients with AVNRT who experience infrequent episodes may not need ongoing treatment, especially if they respond to vagal maneuvers. For individuals with more frequent or serious symptoms, catheter ablation can be a safe and effective option. It has a long-term success rate greater than 95%. […] […] […] Complications […] If left untreated for long periods, uncontrolled AVNRT may cause other cardiac conditions or exacerbate existing ones; these may be reversible if the ventricular arrhythmia is adequately treated. […] AV nodal reentrant tachycardia may complicate the course of treatment and recovery for patients with congenital heart disease (CHD), particularly those affected by volume overload and right heart pressure. In patients with complex CHD, catheter ablation is a riskier procedure, and alternative treatments such as cryoablation may need to be considered.

• #1 Atrioventricular Nodal Reentrant Tachycardia (AVNRT) – Causes, Symptoms, Diagnosis, and Treatment

  https://www.myfastheart.com/conditions-treatment/atrioventricular-nodal-reentrant-tachycardia-avnrt/

  AVNRT is not considered, in and of itself, a dangerous condition. However, in conjunction with certain other heart conditions, it can lead to more severe consequences and even a heart attack (sometimes called demand ischemia). Being distracted the symptoms by AVNRT or passing out from them could lead to dire consequences. For this reason, any irregular heartbeat should be evaluated by a qualified clinician. […] For those that experience infrequent episodes and for whom an episode is not debilitating, there is the option to proceed only with watchful waiting. Patients must understand that this carries some risk and must be on the lookout for worsening of symptoms or condition. […] The ultimate course of treatment largely depends on patient preference, co-occurring conditions and weighing the risks associated with the various options. While medication and various exercises or maneuvers are available for a patient to try, they represent only a potential improvement in symptoms and do not address the underlying issue. Further, antiarrhythmic medications can have significant side-effects that interfere with the patients normal daily function. An effective, long-term solution for AVNRT is a diagnostic electrophysiology (EP) study and subsequent catheter ablation. […] As with most SVTs, there are several potential treatment options, each with their own benefits and drawbacks.

• #1 AVNRT: AV Nodal Reentrant Tachycardia – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/avnrt-av-nodal-reentrant-tachycardia/

  […] […] Monitoring […] After initial treatment for AVNRT, patient education is necessary to promote adherence to follow-up appointments, vagal maneuvers, and ongoing pharmacotherapy as appropriate. Regular follow-up appointments with a cardiovascular specialist may help prevent recurrence of symptoms and enable patients to be monitored for possible long-term complications. This is especially important for patients who do not receive any form of ongoing treatment or those who require pharmacologic treatment.

• #1 Atrioventricular Nodal Reentrant Tachycardia – Core EM

  https://coreem.net/core/avnrt/

  Adenosine causes abrupt slowing of all AV conduction (anterograde and retrograde). […] Verapamil is a class IV antidysrhythmic agent that slows Ca2+ channels and thus, slows conduction at the AV node and suppresses the SA node. […] Most adult patients with AVNRT can be discharged after termination of the tachydysrhythmia. […] Pediatric patients should be considered for admission and further cardiology evaluation. […] Patients with frequent recurrences should be sent to an electrophysiologist for follow up.

• #1 Atrioventricular Nodal Reentrant Tachycardia in Very Elderly Patients: A Single-center Experience

  https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2020/february/1538-atrioventricular-nodal-reentrant-tachycardia

  Prolonged monitoring with an event monitor or a loop recorder allowed for proper diagnosis and treatment in each patient. […] Successful ablation resulted in the complete elimination of symptoms of tachycardia and palpitations in our study group. […] Elderly patients should be evaluated for an arrhythmic etiology when reporting palpitations, as many may benefit from EP study and ablation. […] These procedures are safe and should be offered to all patients as one available management option regardless of patient age.

• #2 Atrioventricular nodal reentry tachycardia (AVNRT) // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/atrioventricular-nodal-reentry-tachycardia-avnrt

  Most people with atrioventricular nodal reentry tachycardia (AVNRT) don’t need treatment. But if the fast heartbeat happens often or lasts a long time, treatment may be needed. […] Treatment for AVNRT may include: […] Vagal maneuvers. Simple but specific actions such as coughing, bearing down as if passing stool, gently massaging the main artery in the neck or putting an ice pack on the face can help slow down the heart rate. These actions affect the vagus nerve, which helps control the heartbeat. […] Medicines. If the fast heartbeat happens frequently, your healthcare professional may prescribe medicines to slow or control your heart rate. […] Cardioversion. Paddles or patches on the chest are used to electrically shock the heart and help reset the heart rhythm. Cardioversion is typically used when vagal maneuvers and medicines don’t work.

• #2 Atrioventricular Nodal Reentrant Tachycardia (AVNRT)

  https://my.clevelandclinic.org/health/diseases/22923-avnrt

  Atrioventricular nodal reentrant tachycardia (AVNRT) is a type of arrhythmia. A person with AVNRT experiences sudden episodes of an abnormally fast heartbeat. Many people with AVNRT dont require treatment, as simple strategies may help prevent and control episodes. But those with rare, severe cases have several treatment options. […] Several treatment strategies are available: Vagal maneuvers: You may be able to stop an episode of AVNRT with simple strategies at home. Examples include coughing, holding your breath or dipping your face in cold water. Electrical cardioversion: Cardioversion delivers an electrical shock to the heart via paddles or patches on your chest. The procedure can restore a normal heart rhythm. Medications: Several medications can regulate heart rate and rhythm. Examples include adenosine injection, antiarrhythmic drugs, calcium channel blockers and beta-blockers. Catheter ablation: Catheter ablation creates scar tissue in heart muscle, which can block faulty electrical signals and cure certain types of arrhythmia, such as AVNRT. […] If you have any symptoms of AVNRT, talk to a healthcare provider about ways to prevent episodes and treatment options.

• #2 Atrioventricular Nodal Reentry Tachycardia Treatment & Management: Approach Considerations, Pharmacologic Therapy, Radiofrequency Catheter Ablation

  https://emedicine.medscape.com/article/160215-treatment

  Rest, reassurance, sedation, and/or vagal maneuvers may terminate an attack of atrioventricular nodal reentry tachycardia (AVNRT). The successful management of an acute attack, however, depends on the symptoms, the presence of underlying heart disease, and the natural history of previous episodes. […] The use of calcium channel blockers is contraindicated in patients with tachycardias of ventricular origin and may cause hemodynamic compromise and death. […] To terminate AVNRT, try vagal maneuvers (eg, carotid sinus massage, exposure of the face to ice water, Valsalva maneuver) before initiating drug treatment. […] Direct-current (DC) synchronized cardioversion is used to terminate an attack if the patient has hemodynamic compromise or if drug conversion fails and the patient continues to be symptomatic.

• #2 AVNRT: AV Nodal Reentrant Tachycardia – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/avnrt-av-nodal-reentrant-tachycardia/

  AVNRT Management […] A hemodynamically stable patient who is experiencing an acute episode of AVNRT should be treated with vagal maneuvers such as carotid sinus massage or Valsalva maneuver to achieve reconversion to sinus rhythm. However, carotid sinus massage should be avoided or used with extreme caution in older adults and patients at risk of stroke. […] Patients for whom vagal maneuvers are not effective may need pharmacotherapy. The first-line medication for acute episodes of AVNRT is intravenous adenosine 6 to 12 mg. If treatment with adenosine is inappropriate or unsuccessful, other intravenous medication options include: […] – A calcium channel blocker (such as verapamil or diltiazem); or […] – A beta blocker (such as metoprolol or esmolol). […] Electrical cardioversion should be used for a patient experiencing an acute episode of AVNRT who is not hemodynamically stable or for whom other treatments are not effective.

• #2 AV Nodal Reentrant Tachycardia: Causes, Symptoms, and TreatmentHealthline

  https://www.healthline.com/health/arrhythmia/av-nodal-reentrant-tachycardia

  Atrioventricular (AV) nodal reentrant tachycardia (AVNRT) is an irregular heart rhythm that can cause excessively fast heart rates. […] The exact treatment plan for AVNRT will depend on the severity of your condition. Options may include: […] Vagal maneuvers: A doctor may recommend guided exercises, such as blowing through your nostrils while holding your nose, to help control the vagus nerve from increasing your heart rate. […] Adenosine: A doctor may recommend this intravenous (IV) medication as a first-line treatment for AVNRT without coronary artery disease or severe lung diseases. […] Other IV medications: If adenosine doesn’t improve AVNRT, a doctor may recommend other antiarrhythmic medications, such as beta-blockers or calcium channel blockers. […] Catheter ablation: This involves the insertion of a catheter through your arteries and the use of energy to stop the heart from receiving irregular signals from the AV node. Experts think that catheter ablation is 95% effective in treating AVNRT. […] Electrical cardioversion: Doctors reserve this procedure for severe cases of AVNRT that have led to severe tachycardia along with chest pain, low blood pressure, or shock.

• #2 Atrioventricular Nodal Reentry Tachycardia Medication: Cardiovascular, Other, Calcium Channel Blockers, Beta-Blockers, Beta-1 Selective

  https://emedicine.medscape.com/article/160215-medication

  Drugs used to terminate an acute episode of atrioventricular nodal reentry tachycardia (AVNRT) are given intravenously. These medications include the following: Adenosine (first line), Calcium channel blockers (eg, diltiazem, verapamil), Beta-blockers (eg, esmolol, propranolol, metoprolol, atenolol), Digitalis. […] Drugs used to prevent recurrences are given orally and include calcium channel blockers, long-acting beta-blockers, and digitalis. […] Adenosine is the preferred medication for IV administration to terminate AVNRT because of its rapid metabolism and generally good safety profile. […] Verapamil is the second-line treatment for AVNRT after adenosine. […] Beta-blockers are used for AV nodal blockade. […] Chronic treatment for AVNRT includes verapamil and diltiazem; beta-blockers (all IIa).

• #2

  https://step2.medbullets.com/evidence/29239759

  Atrioventricular-nodal-reentry tachycardia (AVNRT) is a form of supraventricular tachycardia (SVT) that is relatively common in the emergency department (ED). It is rarely indicative of underlying electrical or structural pathology. […] This review evaluates the literature and controversies concerning treatment of AVNRT in the ED. […] For treatment of narrow-complex tachycardia, Advanced Cardiovascular Life Support guidelines recommend the use of vagal maneuvers, followed by adenosine. Recent literature suggests that nondihydropyridine calcium channel blockers, such as verapamil and diltiazem, may be as effective as adenosine, without the negative short-term side effects. Multiple studies have demonstrated that although adenosine is rapid acting, there is no statistically significant difference in conversion rate between adenosine and calcium channel blockers. Both medications result in a conversion rate above 90%, but there are significantly more minor adverse effects, such as flushing or chest discomfort, with adenosine. Calcium channel blockers are a viable option for treatment for AVNRT, especially in refractory states. Beta-blockers have been evaluated but should not be used routinely due to lower efficacy. AVNRT is the most common tachydysrhythmia in pregnancy, and vagal maneuvers and adenosine are first line. Electrical cardioversion should be utilized for hemodynamically unstable patients. Most patients with AVNRT may be discharged with appropriate follow-up. […] Several studies demonstrate that nondihydropyridine calcium channels (verapamil and diltiazem) are equally as efficacious as adenosine in converting AVNRT to sinus rhythm, without the negative (albeit short-lived) side effects. If given over 20 min, the risk for hypotension is low.

• #2 Atrioventricular Nodal Reentrant Tachycardia – Core EM

  https://coreem.net/core/avnrt/

  Adenosine causes abrupt slowing of all AV conduction (anterograde and retrograde). […] Verapamil is a class IV antidysrhythmic agent that slows Ca2+ channels and thus, slows conduction at the AV node and suppresses the SA node. […] Most adult patients with AVNRT can be discharged after termination of the tachydysrhythmia. […] Pediatric patients should be considered for admission and further cardiology evaluation. […] Patients with frequent recurrences should be sent to an electrophysiologist for follow up.

• #2 AV nodal reentrant tachycardia: Diagnosis and Treatment – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/cardiology/av-nodal-reentrant-tachycardia-diagnosis-and-treatment/

  A. The management of AVNRT proceeds along two lines of therapy. One is empiric drug therapy and the other is catheter ablation for cure of the arrhythmia once acute management has been addressed. […] Patients desiring drug therapy for suppressing of AVNRT should first receive oral beta-blockers or nondihydropyridine calcium channel blockers. Digoxin can be used but it is not preferred due to lower efficacy and higher toxicity. In some cases where beta-blockers and calcium channel blockers are not effective in adequate control of the arrhythmia, type Ic, and occasionally type III, antiarrhythmics can be used. Amiodarone is not a preferred drug for the treatment of AVNRT. […] For patients not desiring drug therapy or those who are drug intolerant, catheter ablation offers a cure rate in excess of 95% with low risk of complications and will be discussed below. For patients with hemodynamic compromise or syncope, catheter ablation is generally the preferred choice in therapy.

• #2 Atrioventricular Nodal Reentrant Tachycardia | Thoracic Key

  https://thoracickey.com/atrioventricular-nodal-reentrant-tachycardia-3/

  For patients with AVNRT who are not candidates for, or prefer not to undergo, catheter ablation, long-term pharmacological therapy can be effective in 30% to 60% of patients. Most pharmacological agents that depress AVN conduction (including beta-blockers and calcium channel blockers) can reduce the frequency of recurrences of AVNRT.

• #2 Diagnosis and treatment of atrioventricular nodal reentrant tachycardia: a case report illustrating clinical management and ablation strategy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7501927/

  Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular arrhythmia that is frequently encountered in an otherwise healthy patient population. Recent guidelines of the European Society of Cardiology underline the role of catheter ablation in the long-term management of these patients. […] Catheter ablation should be considered as an initial treatment choice in symptomatic patients with AVNRT, given the high success rate and low risk for complications. […] In patients with recurrent symptomatic episodes of AVNRT, there is a good and clear indication for catheter ablation, which can be performed with a high success rate (97%) and a very low risk of complications. […] The risk of periprocedural AV block can be minimized by avoiding ablation near the His-bundle and compact AV node. Rather than moving the ablation catheter higher up to the mid-septum if slow pathway conduction cannot be eliminated from the right posteroseptal area, a left-sided approach is recommended to eliminate slow pathway conduction by targeting the leftward inferior extension of the AV node.

• #2 Atrioventricular Nodal Reentrant Tachycardia: Current Perspectives | RRCC

  https://www.dovepress.com/atrioventricular-nodal-reentrant-tachycardia-current-perspectives-peer-reviewed-fulltext-article-RRCC

  Historically, RFCA is the gold standard for AVNRT ablation, presenting a very high acute success and long-term efficacy, consistently over 95% in most of the published series. […] However, it is still associated with a risk of permanent complete AV block (up to 1%). […] Cryoablation, on the other hand, is an effective and safe alternative to RFCA, with no permanent AV block reported in the larger studies, and a comparably excellent acute success rate. […] The treatment of AVNRT relies on both pharmacological and interventional approaches, but during recent years catheter ablation, by both RFCA and cryoenergy, has emerged as the first choice treatment, being highly effective and safe.

• #2 Atrioventricular Nodal Reentrant Tachycardia: Current Perspectives | RRCC

  https://www.dovepress.com/atrioventricular-nodal-reentrant-tachycardia-current-perspectives-peer-reviewed-fulltext-article-RRCC

  Radiofrequency catheter ablation (RFCA) of the slow pathway is, at present, the first choice treatment for AVNRT, presenting high acute success and long-term efficacy. […] An alternative energy source is cryoablation, which was mainly developed to overcome the risk of permanent AV block that can potentially occur with RFCA. […] The aim of this review is to summarize current evidence on AVNRT treatment, focusing on catheter ablation, and in particular on the differences and similarities between RFCA and cryoablation. […] Current guidelines propose catheter ablation as a class I indication and pharmacological treatment as a class IIa alternative, considering patients preference and the clinical opportunities of both approaches. […] Catheter ablation of AVNRT targets the slow pathway, which is activated anterogradely in the typical form of AVNRT.

• #2 Ablation of Atrioventricular Junctional Tachycardias: Atrioventricular Nodal Reentry, Variants, and Focal Junctional Tachycardia – Clinical Tree

  https://clinicalpub.com/ablation-of-atrioventricular-junctional-tachycardias-atrioventricular-nodal-reentry-variants-and-focal-junctional-tachycardia/

  Mechanism of atrioventricular nodal reentrant tachycardia (AVNRT) is reentry involving fast and slow atrioventricular (AV) nodal pathways. […] The ablation target for all variants is the antegrade or retrograde slow pathway. […] Catheter ablation eliminates AVNRT in most patients with a low risk of complications. Therefore it can be offered as a first-line therapy to symptomatic patients and to those who cannot tolerate or do not wish to take antiarrhythmic agents. […] This chapter focuses on the electrophysiology, diagnosis, and ablation of AVNRT and its variants. All forms of AV nodal reentry can be treated by a combined anatomic and electrogram-guided approach, to guide a safe and successful ablation.

• #2 AV nodal reentrant tachycardia: Diagnosis and Treatment – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/cardiology/av-nodal-reentrant-tachycardia-diagnosis-and-treatment/

  If medications are not effective or not desired, then catheter ablation can be undertaken. Generally this can be done with radiofrequency energy (RF) or with the cryoablation technique but as a rule RF catheter ablation is more efficacious with less chance of recurrence and is generally the procedure of choice for ablation of AVNRT. […] Catheter ablation for therapy of AVNRT is generally done under conscious sedation in the electrophysiology laboratory. […] Application of RF energy at this site generally leads to destruction of the slow pathway and cure of AVNRT.

• #2 AVNRT: AV Nodal Reentrant Tachycardia – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/avnrt-av-nodal-reentrant-tachycardia/

  Patients with AVNRT who experience infrequent episodes may not need ongoing treatment, especially if they respond to vagal maneuvers. For individuals with more frequent or serious symptoms, catheter ablation can be a safe and effective option. It has a long-term success rate greater than 95%. […] […] […] Complications […] If left untreated for long periods, uncontrolled AVNRT may cause other cardiac conditions or exacerbate existing ones; these may be reversible if the ventricular arrhythmia is adequately treated. […] AV nodal reentrant tachycardia may complicate the course of treatment and recovery for patients with congenital heart disease (CHD), particularly those affected by volume overload and right heart pressure. In patients with complex CHD, catheter ablation is a riskier procedure, and alternative treatments such as cryoablation may need to be considered.

• #2 Atrioventricular Nodal Reentrant Tachycardia

  https://mydoctor.kaiserpermanente.org/mas/structured-content/Condition_AV_Nodal_Reentrant_Tachycardia_-_Cardio_EP.xml?co=/regions/mas

  AVNRT is treatable. We’ll talk with you about treatment options and develop a plan that’s best for you. Our goal is to manage symptoms and prevent episodes of rapid heartbeat. […] Treatment will depend on how often you have AVNRT episodes and how severe and long-lasting your symptoms are. […] Here are the main treatment options. […] If your AVNRT episodes don’t happen often, you may be able to use specific maneuvers to calm your rapid heartbeat. […] Specific drugs that slow the heart rate can help prevent AVNRT. These include long-acting beta blockers, calcium channel blockers, and digitalis. […] We guide a narrow tube (catheter) tipped with an electrode into the heart. It sends high-frequency, low-voltage electricity (radiofrequency energy) to the AV node’s slow pathway area. By destroying (ablating) specific heart muscle cells, the extra electrical signals that cause AVNRT can’t be sent. […] Catheter ablation has a high cure rate and low risk of complications. Possible complications include bleeding where the catheter is inserted and blood vessel damage.

• #2 Atrioventricular Nodal Reentrant Tachycardia in Very Elderly Patients: A Single-center Experience

  https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2020/february/1538-atrioventricular-nodal-reentrant-tachycardia

  Prolonged monitoring with an event monitor or a loop recorder allowed for proper diagnosis and treatment in each patient. […] Successful ablation resulted in the complete elimination of symptoms of tachycardia and palpitations in our study group. […] Elderly patients should be evaluated for an arrhythmic etiology when reporting palpitations, as many may benefit from EP study and ablation. […] These procedures are safe and should be offered to all patients as one available management option regardless of patient age.

• #3 Atrioventricular Nodal Reentry Tachycardia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17974

  Atrioventricular nodal reentrant tachycardia (AVNRT) is a type of paroxysmal supraventricular tachycardia that results due to the presence of a reentry circuit within or adjacent to the AV node. […] Management of patients presenting with atrioventricular nodal reentry tachycardia begins with an initial evaluation of their hemodynamic stability. Hemodynamically unstable patients present with tachycardia associated with hypotension, ischemic chest pain, altered mental status, respiratory failure, or shock. These patients need their AVNRT terminated electrically with an urgent electrical cardioversion. […] First-line medical therapy is IV adenosine, administered up to 18 mg given in increments of 6 mg in the absence of contraindications such as severe bronchospastic lung disease or severe coronary artery disease.

• #3 Atrioventricular Nodal Reentrant Tachycardia – Core EM

  https://coreem.net/core/avnrt/

  AVNRT is a common tachydysrhythmia that results from a reentrant loop within the AV node. […] Unstable patients with AVNRT should be considered for immediate synchronized electrical cardioversion. […] Stable patients with AVNRT can have a trial of vagal maneuvers followed by chemical cardioversion with adenosine or verapamil and synchronized electrical cardioversion if that fails. […] The primary goal is to convert the patient back to sinus rhythm. […] If the patient is unstable, proceed directly to electrical cardioversion. […] If the patient is stable, you may pursue non-pharmacological therapy with vagal maneuvers, electrical cardioversion or chemical cardioversion. […] Synchronized cardioversion is indicated for unstable patients with AVNRT. […] Synchronized cardioversion can also be strongly considered in stable patients with AVNRT.

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