Guideline sources The following summarized guidelines for the management of atrioventricular nodal reentrant tachycardia are prepared by our editorial team based on guidelines from the European Society of Cardiology (ESC 2020) and the American Heart Association (AHA/HRS/ACC 2016). 1 2 Calculator NYHA functional classification f Guidelines 1. Medical management Acute management: Administer IV adenosine (6-18 mg bolus) for acute management of hemodynamically stable patients with AVNRT if vagal maneuvers fail. B Consider administering IV formulations of the following medications for acute management of hemodynamically stable patients with AVNRT if vagal maneuvers and adenosine fail: nondihydropyridine CCBs, i.e. verapamil or diltiazem https://web.pathway.md/diseases/recAWt2YZMRL8w8HW 1/3 6/23/23, 3:15 AM Atrioventricular nodal reentrant tachycardia Pathway -blockers, i.e. esmolol or metoprolol. C Administer adenosine for acute management of patients with AVNRT. B Show 2 more Ongoing management: Consider initiating the following medications for the management of patients with AVNRT if ablation is not desirable or feasible: nondihydropyridine CCBs (verapamil or diltiazem) in the absence of HFrEF -blockers. C Consider offering abstinence from therapy in patients with minimally symptomatic patients with very infrequent, short-lived episodes of AVNRT. C Initiate oral formulations of the following medications for ongoing management of patients with AVNRT not being candidates for, or preferring not to undergo, catheter ablation: verapamil diltiazem -blockers. B Show 3 more 2. Nonpharmacologic interventions Vagal maneuvers: Perform vagal maneuvers, preferably in the supine position with leg elevation, for acute management of hemodynamically stable patients with AVNRT. B Perform vagal maneuvers for acute management of patients with AVNRT. B 3. Therapeutic procedures Synchronized electrical cardioversion: Perform synchronized direct current cardioversion for acute management of hemodynamically unstable patients with AVNRT. B Perform synchronized direct current cardioversion for acute management of hemodynamically stable patients with AVNRT if drug therapy fails to convert or control the tachycardia. B Perform synchronized cardioversion for acute management of hemodynamically unstable patients with AVNRT if adenosine and vagal maneuvers do not terminate the tachycardia or are not feasible. B Perform synchronized cardioversion for acute management of hemodynamically stable patients with AVNRT if pharmacological therapy does not terminate the tachycardia or is contraindicated. B Catheter ablation: https://web.pathway.md/diseases/recAWt2YZMRL8w8HW 2/3 6/23/23, 3:15 AM Atrioventricular nodal reentrant tachycardia Pathway Perform catheter ablation for the management of patients with is recommended for symptomatic recurrent AVNRT. B Perform catheter ablation of the slow pathway in patients with AVNRT. B 4. Follow-up and surveillance Follow-up: consider obtaining clinical follow-up without pharmacological therapy or ablation for ongoing management of minimally symptomatic patients with AVNRT. C References 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 2. Richard L Page, Jos A Joglar, Mary A Caldwell et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2016 Apr 5;133 14):e471 505. Open https://web.pathway.md/diseases/recAWt2YZMRL8w8HW 3/3