TABLE 3

Recommendations for Long-Term Treatment of Patients With Recurrent AVNRT

Clinical PresentationRecommendationClassLevel of EvidenceReferences
Poorly tolerated AVNRT with hemodynamic intoleranceCatheter ablationIB58
Verapamil, diltiazem, beta blockers, sotalol, amiodaroneIIaC58
Flecainide,; propafenoneIIaC
Recurrent symptomatic AVNRTCatheter ablationIB58
VerapamilIB59
Diltiazem, beta blockersIC60
DigoxinIIbC
Recurrent AVNRT unresponsive to beta blockade or calcium-channel blocker and patient not desiring RF ablationFlecainide,propafenone,sotalolIIaB53,61–65
AmiodaroneIIbC66
AVNRT with infrequent or single episode in patients who desire complete control of arrhythmiaCatheter ablationIB
Documented PSVT with only dual AV-nodal pathways or single echo beats demonstrated during electrophysiological study and no other identified cause of arrhythmiaVerapamil, diltiazem, beta blockers, flecainide,propafenoneIC
Catheter ablationIB
Infrequent, well-tolerated AVNRTNo therapyIC58
Vagal maneuversIB
Pill-in-the-pocketIB
Verapamil, diltiazem, beta blockersIB
Catheter ablationIB67

The order in which treatment recommendations appear in this table within each class of recommendation does not necessarily reflect a preferred sequence of administration. Please refer to text for details. For pertinent drug dosing information please refer to the ACC/AHA/ESC Guidelines on the Management of Patients With Atrial Fibrillation.

AV indicates atrioventricular; AVNRT, atrioventricular nodal reciprocating tachycardia; LV, left ventricular; PSVT, paroxysmal supraventricular tachycardia; RF, radiofrequency.

  • Relatively contraindicated for patients with coronary artery disease, LV dysfunction, or other significant heart disease.

  • Digoxin is often ineffective because its pharmacologic effects can be overridden by enhanced sympathetic tone.

  • Decision depends on symptoms.