Materiały źródłowe

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

  https://angolodeldottorino.it/en/Medicine/Cardiology/heart-rhythm-disorders/atrioventricular-nodal-reentrant-tachycardia.php

  Atrioventricular nodal reentrant tachycardia (AVNRT) develops in individuals with an anatomical predisposition characterized by the presence of dual conduction pathways within the AV node. This congenital condition is found in approximately 30% of the population, although only a subset develops episodes of tachycardia. […] Overactivity of the sympathetic nervous system plays a crucial role in modulating AVNRT. Factors such as stress, anxiety, and intense physical exercise can lower the threshold for tachycardia initiation, facilitating the activation of the reentry circuit. […] Prevention of AVNRT relies on managing predisposing factors and controlling episodes. In patients with recurrent episodes, it is advisable to reduce the intake of stimulant substances, such as caffeine and alcohol, and to adopt strategies to manage stress, such as relaxation techniques or biofeedback. […] Furthermore, in individuals experiencing frequent AVNRT episodes, discontinuation of potentially proarrhythmic medications should be considered, along with regular monitoring of serum electrolytes to prevent imbalances that could facilitate tachycardia.

• #2 Atrioventricular Nodal Reentrant Tachycardia (AVNRT)

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

  Many people with AVNRT dont require treatment, as simple strategies may help prevent and control episodes. […] Theres no proven way to prevent AVNRT. But if you have the condition, you may notice that certain things are more likely to lead to AVNRT episodes. […] If you avoid triggers, you may be able to reduce the frequency of episodes. Triggers may include: Alcohol, Caffeine, Certain types of exercise (talk to your healthcare provider), Herbal supplements, Recreational drugs, Smoking or using tobacco products, Stress. […] If you have any symptoms of AVNRT, talk to a healthcare provider about ways to prevent episodes and treatment options.

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

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

  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. […] Drugs that are used for prevention of recurrence include long-acting beta-blockers, calcium channel blockers, and digitalis alone or in combination. […] No comparative studies indicate that a calcium channel antagonist is preferable or superior to a beta-adrenergic blocker for long-term management.

• #4 AV Nodal Reentrant Tachycardia (AVNRT)

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

  AV nodal reentry tachycardia, AVNRT, as an isolated rhythm disturbance, is not considered a life-threatening condition. […] Some patients are able to reduce their symptomatic episodes with life-style modification, including avoidance of caffeinated beverages, alcohol, sleep-deprivation, stressful situations, and anxiety. […] Because the arrhythmia is due to an abnormal electrical circuit in the heart, there is little any patient can do by himself or herself to prevent or suppress the arrhythmia completely. […] There is no role for antiarrhythmic drug therapy for AVNRT if continued symptomatic breakthrough episodes occur despite lifestyle modifications and oral b-blockers or calcium-channel blockers. […] The risks of radiofrequency catheter ablation for AVNRT are very small and will be discussed in detail with each patient by their heart rhythm specialist at the time of the initial office visit.

• #5 Atrioventricular nodal reentry tachycardia (AVNRT)

  https://www.mymlc.com/health-information/diseases-and-conditions/a/atrioventricular-nodal-reentry-tachycardia-avnrt/

  Atrioventricular nodal reentry tachycardia (AVNRT) is the most common type of supraventricular tachycardia. […] To prevent an episode of supraventricular tachycardia, it’s important to know what triggers the episodes to occur and try to avoid them. You might want to try: […] For most people with supraventricular tachycardia, moderate amounts of caffeine do not trigger an episode. Large amounts of caffeine should be avoided, however. […] Your doctor may suggest that, in addition to other treatments, you make lifestyle changes that will keep your heart as healthy as possible. […] These lifestyle changes may include: […] Research is ongoing regarding the effectiveness of several forms of complementary and alternative medical therapies for supraventricular tachycardia. […] Some studies have shown that acupuncture may help reduce irregular heart rates in certain arrhythmias, but further research is needed. […] The role of omega-3 fatty acids, a nutrient found mostly in fish, in the prevention and treatment of arrhythmias isn’t yet clear. But it appears as though this substance may be helpful in preventing and treating some arrhythmias.

• #6 Atrioventricular Nodal Reentrant Tachycardia

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

  AVNRT isn’t life-threatening because the fast heart rhythm is steady, not chaotic. AVNRT can be prevented, managed, and sometimes cured with treatment. […] Treatment will depend on how often you have AVNRT episodes and how severe and long-lasting your symptoms are. […] Specific drugs that slow the heart rate can help prevent AVNRT. These include long-acting beta blockers, calcium channel blockers, and digitalis. […] Avoid coffee and other caffeinated beverages and foods. They can trigger an episode.

• #7 AV nodal reentrant tachycardia – Wikipedia

  https://en.wikipedia.org/wiki/AV_nodal_reentrant_tachycardia

  AVNRT occurs when a reentrant circuit forms within or just next to the atrioventricular node. […] Treatments for AVNRT aim to terminate episodes of tachycardia, and to prevent further episodes from occurring in the future. These treatments include physical manoeuvres, medication, and invasive procedures such as ablation. […] While preventative treatment may be very helpful at stopping the unpleasant symptoms associated with AVNRT, as this arrhythmia is a benign condition, preventative treatment is not essential. […] Those who wish to have further treatment can choose to take long term antiarrhythmic medication. The first line drugs are calcium channel antagonists and beta blockers, with second line agents including flecainide, amiodarone, and occasionally digoxin. […] Alternatively, an invasive procedure called an electrophysiology (EP) study and catheter ablation can be used to confirm the diagnosis and potentially offer a cure. […] Catheter ablation of the slow pathway, if successfully carried out, can potentially cure AVNRT with success rates of 95%, balanced against a small risk of complications including damaging the AV node and subsequently requiring a pacemaker.

• #8 Atrioventricular nodal reentry tachycardia (AVNRT): ECG features & management – The Cardiovascular

  https://ecgwaves.com/topic/av-atrioventricular-nodal-reentrant-tachyarrrhythmia-reentry/

  Atrioventricular nodal reentrant tachycardia (AVNRT) is a common tachyarrhythmia observed across all age groups, from children to the elderly, and frequently occurs in otherwise healthy individuals. […] Patients with recurring episodes of AVNRT should be considered for long-term/prophylactic treatment with beta-blockers, calcium channel blockers or digoxin. […] Radiofrequency ablation cures virtually all patients who are referred for intervention.

• #9 Supraventricular tachycardia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/supraventricular-tachycardia/

  A tachyarrhythmia caused by a dysfunctional AV node that contains two electrical pathways, which form a reentry circuit. […] The AV node contains two electrical pathways, one fast and one slow; the electrical impulse circles around the AV node within both pathways, a continuous circuit conducts impulses to the ventricles, leading to tachycardia. […] Infrequent and mild episodes of AVNRT may be managed with self-guided vagal maneuvers. […] First line for long-term management of AVNRT is percutaneous catheter ablation of the slow pathway. […] Second line for long-term management of AVNRT is pharmacological therapy, including daily medication options such as beta blockers, verapamil, or diltiazem. […] Avoid AV nodal blockers in patients with preexcited focal atrial tachycardia because they can trigger ventricular arrhythmias. […] Avoid AV nodal blocking agents and vagal maneuvers for the following preexcited tachycardias: Afib, Aflut, focal AT, and MAT.

• #10

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

  Atrioventricular (AV) tachycardia includes both AV nodal reentrant tachycardia (AVNRT) and AV reentrant tachycardia (AVRT) using an accessory pathway. […] 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.

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

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

  Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common, highly symptomatic paroxysmal supraventricular tachycardia. […] The treatment of this arrhythmia includes acute termination, which can usually be achieved by vagal maneuvers or intravenous adenosine, while beta-blockers or non-dihydropyridine Ca-channel blockers are rarely needed, and the prevention of recurrent episodes. Prophylaxis can be pursued by a pharmacological approach, mainly with beta-blockers, verapamil or diltiazem, continuously or on demand, which is usually effective in only around 60-80% in most series, or interventional treatment with catheter ablation, aimed at definitely interrupting the conduction over the slow pathway and therefore being curative; in 2017, a randomized trial showed higher efficacy and significant reduction of hospitalizations in patients treated with catheter ablation compared to drugs.

• #12 Atrioventricular Nodal Reentrant Tachycardia (AVNRT) – Supraventricular Tachycardias – Supraventricular Arrhythmias – Cardiac Arrhythmias – Cardiovascular Diseases – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.2.6.2.

  Atrioventricular nodal reentrant tachycardia (AVNRT) is a paroxysmal tachycardia that occurs in patients with dual atrioventricular (AV) node physiology, as they have both a fast nodal pathway with a longer refractory period and a slow nodal pathway with a shorter refractory period. It is most commonly observed in individuals with no underlying structural heart disease. […] In patients with frequently recurring AVNRT attacks who prefer long-term oral treatment to ablation, use diltiazem, verapamil, or a betablocker. […] In patients with no structural heart disease who do not respond to drugs that inhibit AV node conduction (see above), use flecainide or propafenone. […] In patients with poorly tolerated AVNRT, recurrent attacks, and significant symptoms, as well as in those with mild and well-tolerated symptoms who wish to achieve a complete cure of AVNRT, catheter ablation of the slow pathway is indicated. This is the most successful treatment method, although associated with a low risk (0.5%-1%) of AV block requiring pacemaker implantation.

• #13 High incidence of atrial fibrillation after successful catheter ablation of atrioventricular nodal reentrant tachycardia: a 15.5-year follow-up | Scientific Reports

  https://www.nature.com/articles/s41598-019-47980-1

  Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of supraventricular tachycardia. Slow pathway (SP) ablation is the treatment of choice with a high acute success rate and a negligible periprocedural risk. […] The unexpectedly high incidence of new-onset AF (11.9%) may impact long-term follow-up and requires further clinical attention. […] Catheter ablation of the slow pathway (SP) has evolved as the treatment of choice over long-term pharmacologic therapy for symptomatic AVNRT. […] In patients with manifest or concealed accessory pathways and documented AF, older age was a significant independent predictor for the recurrence of AF after RF ablation of the accessory pathway. […] In our study, a repeat ablation performed in 2.1% of patients one to ten years after the initial procedure rendered all patients asymptomatic.

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

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

  Catheter ablation of AVNRT targets the slow pathway, which is activated anterogradely in the typical form of AVNRT. […] 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. […] 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.

• #15 Catheter Ablation of Atrioventricular Nodal Re-entrant Tachycardia: Facts and Fiction | AER Journal

  https://www.aerjournal.com/articles/catheter-ablation-atrioventricular-nodal-re-entrant-tachycardia-facts-and-fiction?language_content_entity=en

  Although the exact circuit of atrioventricular nodal re-entrant tachycardia (AVNRT) still eludes us, AVNRT is the most common regular arrhythmia in humans, and therefore the most commonly encountered during ablation attempts for regular tachycardias. Catheter ablation for AVNRT is the current treatment of choice in symptomatic patients. It reduces arrhythmia-related hospitalisations and costs, and substantially improves quality of life. Catheter ablation approaches aimed at the fast pathway have been abandoned; slow pathway ablation, using a combined anatomical and mapping approach, is now the method of choice. This approach offers a success rate of 95 %, has a recurrence rate of approximately 1.34.0 %, and has been associated with a low risk of atrioventricular (AV) block that in most, but not all, studies is 1 %.

• #16 Catheter Ablation of Atrioventricular Nodal Re-entrant Tachycardia: Facts and Fiction | AER Journal

  https://www.aerjournal.com/articles/catheter-ablation-atrioventricular-nodal-re-entrant-tachycardia-facts-and-fiction?language_content_entity=en

  Slow pathway ablation or modification as described is effective in both typical and atypical AVNRT. This procedure can be accomplished in both typical and atypical AVNRT with no risk of AV block. We now have substantial evidence demonstrating that we can offer a radical cure for this arrhythmia without any subsequent need for permanent pacing. […] Recurrence rates are 2 % in typical and 5 % in atypical AVNRT. Recurrence is usually seen within the 3 months following a successful procedure in symptomatic patients with frequent episodes of tachycardia. However, in those aged 18 years, recurrence may occur up to 5 years post-ablation. Advanced age is not a contraindication for slow pathway ablation. The pre-existence of first-degree heart block carries a higher risk of late AV block and the avoidance of extensive slow pathway ablation is preferable in this setting.

• #17 High incidence of atrial fibrillation after successful catheter ablation of atrioventricular nodal reentrant tachycardia: a 15.5-year follow-up | Scientific Reports

  https://www.nature.com/articles/s41598-019-47980-1

  Notably, procedure related AH prolongation does not play a role in the prediction of future PM implantation because only 2 out of 143 patients with AH prolongation (8 and 15ms) required a PM implantation later on, whereas AH interval was unchanged or even shorter post ablation in the other 9 patients receiving a PM. […] An unexpected observation was that 11.9% of patients developed new-onset AF after successful SP ablation. […] Our data show that extension of follow-up to a 15 year-period is still associated with a low recurrence rate of AVNRT (2.7%). […] This highlights the role of AVNRT as trigger arrhythmia for AF in a selected subgroup of patients. […] In conclusion, the present study which is the largest long-term follow-up study after ablation for AVNRT confirms that SP-ablation has a high success rate also more than fifteen years after ablation.

• #18 Atrioventricular Nodal Reentry Tachycardia – MD Searchlight

  https://mdsearchlight.com/heart-health/atrioventricular-nodal-reentry-tachycardia/

  Teaching patients who are prone to this heart rhythm about their condition can greatly improve how its managed. Ensuring regular and open communication between these patients and their healthcare providers also plays a crucial role in the effective management of these heart rhythms.

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

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

  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.8 […] 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.

• #20 Radiofrequency catheter ablation of atrioventricular nodal reentry tachycardia in children and adolescents: a single center experience

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

  Atrioventricular nodal reentry tachycardia (AVNRT) is less common in pediatric patients than in adult patients. […] 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 highlights the need for the establishment of ablation endpoint for pediatric AVNRT patients as well as research on risk factors for AVNRT recurrence. However, this was difficult to achieve via a single-center analysis with a limited number of patients. Therefore, an additional multicenter study with large pediatric patient cohorts is necessary.

• #21

  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. […] For treatment of narrow-complex tachycardia, Advanced Cardiovascular Life Support guidelines recommend the use of vagal maneuvers, followed by adenosine. […] 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. […] Calcium channel blockers are a viable option for treatment for AVNRT, especially in refractory states. […] AVNRT is the most common tachydysrhythmia in pregnancy, and vagal maneuvers and adenosine are first line. […] 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.

• #22 Successful Management of an Atrioventricular Nodal Re-entrant Tachycardia in a Neonate: A Case Report

  https://brieflands.com/articles/jcp-112484

  The most common tachyarrhythmias in fetal cases is supraventricular tachycardia (SVT); atrioventricular nodal re-entrant tachycardia (AVNRT) type. […] Premature delivery and neonatal complications, and mortality following fetal SVT are high, and therefore, require proper management. […] If the arrhythmia persists and proper action is not taken, fetal hydrops and fetal death occur in 30 – 40% and 8 – 9%, respectively. […] Digoxin is currently the first line, and adenosine, beta-blocker is the next step in treatment of SVT. […] The first line of treatment for fetal SVT is digoxin, and flecainide is preferred if the fetus has hydrops fetalis. […] Although adenosine was not effective in our patient after delivery, many studies have reported adenosine as the most effective and safest drug for AVNRT in neonates and infants. […] Yet, propranolol and flecainide are also effective treatments in pediatric arrhythmias, as were beneficial in our patient. […] This study showed that AVNRT is sometimes not easily controlled, contrary to previous perception, and that flecainide can be used as a suitable drug for these patients.

• #23 Reentrant Arrhythmias | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28298

  Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common reentrant supraventricular tachycardia and utilizes the atrioventricular (AV) node as its reentry circuit. […] Atrioventricular nodal reentrant tachycardia has an excellent prognosis, and more than 95% of people remain free of arrhythmias after successful ablation and modification of the slow atrioventricular nodal pathway. […] After initial management, all patients with AVNRT and AVRT should be referred to an electrophysiologist for catheter ablation. Catheter ablation for AVNRT/AVRT is a very safe procedure in the contemporary era, and it has a very high success and very low recurrence. In AVNRT, the cure rate is above 95%, with complications below 1%. […] Adenosine is a good treatment option in a patient where the AV node is the origin of arrhythmia; however, it can be catastrophic in a patient with a circuit formed by an accessory pathway. If adenosine is given to a patient with Wolff-Parkinson-White syndrome, the AV node will be blocked by the medications. However, the accessory pathway will remain uninhibited, which can lead to ventricular fibrillation and possible cardiac arrest. […] In conclusion, adenosine is a great treatment modality for patients with AVNRT, but clinicians should be cautious in its use with patients who have WPW, making imperative the need for accurate diagnostic measures prior to treatment.

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