Guideline 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). 1 Calculator NYHA functional classification f Guidelines 1. Medical management Acute management: 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 https://web.pathway.md/diseases/recyPWdx5A3BvHCJF 1/3 6/23/23, 2:39 AM Antidromic atrioventricular reentrant tachycardia Pathway profanenone. C Consider administering IV amiodarone for acute management of hemodynamically stable patients with refractory antidromic atrioventricular reentrant tachycardia. C Ongoing management: Consider initiating the following medications for the management of patients with antidromic atrioventricular reentrant tachycardia and without signs of pre-excitation on resting ECG, if ablation is not desirable or feasible: -blockers nondihydropyridine CCBs (verapamil or diltiazem) in the absence of HFrEF. (Class IIa, Level B) consider initiating the following medications for the management of patients with antidromic atrioventricular reentrant tachycardia and without ischemic or structural heart disease, if ablation is not desirable or feasible: propafenone flecainide. C Do not use the following medications in patients with pre-excited AF: -blockers nondihydropyridine CCBs (verapamil or diltiazem) digoxin amiodarone. D 2. Nonpharmacologic interventions Vagal maneuvers: perform vagal maneuvers, preferably in the supine position with leg elevation, for acute management of hemodynamically stable patients with antidromic atrioventricular reentrant tachycardia. B 3. Therapeutic procedures Synchronized electrical cardioversion: perform synchronized direct current cardioversion for acute management of hemodynamically unstable patients with antidromic atrioventricular reentrant tachycardia. B Show 2 more Catheter ablation: perform catheter ablation of accessory pathways in patients with symptomatic, recurrent antidromic atrioventricular reentrant tachycardia. B References https://web.pathway.md/diseases/recyPWdx5A3BvHCJF 2/3 6/23/23, 2:39 AM Antidromic atrioventricular reentrant tachycardia Pathway 1. Josep Brugada, Demosthenes G Katritsis, Elena Arbelo et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology ESC . Eur Heart J. 2020 Feb 1;41 5 655 720. Open https://web.pathway.md/diseases/recyPWdx5A3BvHCJF 3/3