The AHA Guidelines and Scientific Statements Handbook

The AHA Guidelines and Scientifi c Statements Handbook

Table 16.5 Recommendations for long-term therapy of accessory pathway-mediated arrhythmias

Arrhythmia Recommendation Classifi cation Level of evidence

WPW syndrome preexcitation and symptomatic
arrhythmias, well tolerated

Catheter ablation I B

Flecainide, propafenone IIa C

Sotalol, amiodarone, beta-blockers Ia C

Verapamil, diltiazem, digoxin II C

WPW syndrome (with AF and rapid-conduction or
poorly tolerated AVRT)

Catheter ablation I B

AVRT, poorly tolerated (no preexcitation) Catheter ablation I B
Flecainide, propafenone IIa C
Sotalol, amiodarone IIa C
Beta-blockers IIb C
Verapamil, diltiazem, digoxin II C

Single or infrequent AVRT episode(s) (no
preexcitation)

None I C

Vagal maneuvers I B

Pill-in-the-pocket – verapamil, diltiazem,

beta-blockers

IB

Catheter ablation Ia B

Sotalol, amiodarone IIb B

Flecainide, propafenone IIb C

Digoxin II C

Preexcitation, asymptomatic None I C
Catheter ablation Ia B

The order in which treatment recommendations appear in this table within each class of recommendation does not necessarily refl ect a preferred sequence of admin-
istration. 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.
AF indicates atrial fi brillation; AVRT, atrioventricular reciprocating tachycardia; WPW, Wolff–Parkinson–White.

distinguish micro re-entry from abnormal automa-
ticity. Incessant atrial tachycardia is usually seen in
children or young adults and may produce a tachy-
cardic myopathy.

Diagnoses
The diagnoses should be suspected when the patient
presents with a long RP tachycardia where the P
wave is different from sinus and is not compatible
with retrograde activation from the AV node. In
addition, if adenosine results in AV block with per-

sistence of tachycardia, then the diagnoses is almost

always atrial tachycardia.

Tr e a t m e n t

Acute therapy of FAT includes initial trials of

adenosine (effective in 20–30% of cases) or other

AV nodal blockers (beta-blockers or Ca++ channel

blockers). The latter drugs seldom terminate

the tachycardia, but may be used to achieve rate

control by AV nodal blockade. Direct-current