P1: SBT
0521779407-05 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:49
AV Reentrant Tachycardia (AVRT) AV-Nodal Reentrant Tachycardia 211■Emergency DC cardioversion (synchronized to R wave) to restore
NSR if rapid ventricular response causes hemodynamic instability,
especially atrial fibrillation with very rapid response or atrial flutter
with 1:1 AV conduction.
■Vagal maneuvers (carotid sinus massage, Valsalva) followed by IV
adenosine. IV beta blockers (metoprolol, esmolol) or calcium chan-
nel blockers (verapamil, diltiazem), or IV procainamide.
Chronic
■RF ablation of pathway is Rx of choice.
■Otherwise: beta blockers or calcium channel blockers (verapamil,
diltiazem), or Class IA, IC and III antiarrhythmic drugs.Side Effects & Contraindications
■Betab blockers and calcium channel blockers contraindicated in
atrial fibrillation and flutter in WPW syndrome (VF from increased
ventricular rate). AF possible after adenosine Rx.follow-up
■Holter to monitor presence of AVRT, atrial fibrillation or flutter
complications and prognosis
■None if no tachycardias and delta wave only. Rapid ventricular
response leading to ventricular fibrillation and sudden death in WPW
syndrome.AV-Nodal Reentrant Tachycardia (AVNRT)..................
EDMUND C. KEUNG, MD
history & physical
History
■Most common form of SVT. More frequent in women (66%). Heart
disease often absent. Rare atypical form often incessant.Signs & Symptoms
■Palpitation, usually regular rapid pulse. Depending on co-existing
cardiac conditions and rate of ventricular response:, dizziness,
hypotension, syncope, shortness of breath (with reduced left ven-
tricular function), chest pain (with significant coronary heart dis-
ease).