Management of atrioventricular nodal re-entrant tachycardia
THE CONTEXT
Management includes termination of acute episodes and prevention of recurrent supraventricular tachycardia (SVT). Treatment is not always necessary.
Termination of an acute episode
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Carotid sinus pressure or the Valsalva manoeuvre may terminate an episode.
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Adenosine, given rapidly intravenously in incremental doses of 3–12 mg until tachycardia stops, or verapamil, given as 5 mg intravenously over 1 minute, restores sinus rhythm in most cases.
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An intravenous β-blocker or flecainide can also be used.
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Severe haemodynamic compromise requires termination by DC cardioversion.
Prevention of recurrence
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Catheter ablation is the most effective treatment for recurrent SVT, permanently preventing it in around 95% of cases with a very small risk of complications.
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Oral β-blockers, verapamil or flecainide are alternatives for prophylaxis, but require long-term drug treatment in predominantly young patients.
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These prophylactic drugs should be avoided during pregnancy where possible.