Table 12. Ongoing Management of Orthodromic AVRT
COR
LOE Recommendations
I B-NR Catheter ablation of the accessory pathway is recommended in
patients with AVRT and/or pre-excited AF.
I C-LD Oral beta blockers, diltiazem, or verapamil are indicated for
ongoing management of AVRT in patients without pre-excitation
on their resting ECG.
IIa B-R Oral flecainide or propafenone is reasonable for ongoing
management in patients without SHD or ischemic heart disease
who have AVRT and/or pre-excited AF and are not candidates
for, or prefer not to undergo, catheter ablation.
IIb B-R Oral dofetilide or sotalol may be reasonable for ongoing
management in patients with AVRT and/or pre-excited AF who
are not candidates for, or prefer not to undergo, catheter ablation.
IIb C-LD Oral amiodarone may be considered for ongoing management
in patients with AVRT and/or pre-excited AF who are not
candidates for, or prefer not to undergo, catheter ablation and
in whom beta blockers, diltiazem, flecainide, propafenone, and
verapamil are ineffective or contraindicated.
IIb C-LD Oral beta blockers, diltiazem, or verapamil may be reasonable for
ongoing management of orthodromic AVRT in patients with
pre-excitation on their resting ECG who are not candidates for,
or prefer not to undergo, catheter ablation.
IIb C-LD Oral digoxin may be reasonable for ongoing management of
orthodromic AVRT in patients without pre-excitation on their
resting ECG who are not candidates for, or prefer not to undergo,
catheter ablation.
III:
Harm
C-LD Oral digoxin is potentially harmful for ongoing management in
patients with AVRT or AF and pre-excitation on their resting
ECG.
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