15
Symptomatic Manifest or Concealed Accessory Pathways
Table 11. Acute Treatment of Orthodromic AVRT
COR
LOE Recommendations
I B-R Vagal maneuvers are recommended for acute treatment in
patients with orthodromic AVRT.
I B-R Adenosine is beneficial for acute treatment in patients with
orthodromic AVRT.
I B-NR Synchronized cardioversion should be performed for acute
treatment in hemodynamically unstable patients with AVRT if
vagal maneuvers or adenosine are ineffective or not feasible.
I B-NR Synchronized cardioversion is recommended for acute
treatment in hemodynamically stable patients with AVRT when
pharmacological therapy is ineffective or contraindicated.
I B-NR Synchronized cardioversion should be performed for acute
treatment in hemodynamically unstable patients with pre-excited
AF.
I C-LD Ibutilide or IV procainamide is beneficial for acute treatment in
patients with pre-excited AF who are hemodynamically stable.
IIa B-R IV diltiazem, verapamil (LOE: B-R) or beta blockers (LOE:
C-LD) can be effective for acute treatment in patients with
orthodromic AVRT who do not have pre-excitation on their
resting ECG during sinus rhythm.
C-LD
IIb B-R IV beta blockers, diltiazem, and verapamil might be considered
for acute treatment in patients with orthodromic AVRT who
have pre-excitation on their resting ECG and have not responded
to other therapies.
III:
Harm
C-LD IV digoxin, IV amiodarone, IV or oral beta blockers, diltiazem,
and verapamil are potentially harmful for acute treatment in
patients with pre-excited AF.
