ACHD
Table 19. Acute Treatment of ACHD
COR
LOE Recommendations
I C-LD Acute antithrombotic therapy is recommended in ACHD
patients who have AT or atrial flutter to align with recommended
antithrombotic therapy for patients with AF.
I B-NR Synchronized cardioversion is recommended for acute treatment
in ACHD patients and SVT who are hemodynamically unstable.
I C-LD IV diltiazem or esmolol (with extra caution using either agent,
observing for the development of hypotension) is recommended
for acute treatment in ACHD patients and SVT who are
hemodynamically stable.
I B-NR IV adenosine is recommended for acute treatment in ACHD
patients and SVT.
IIa B-NR IV ibutilide or procainamide can be effective for acute treatment
in ACHD patients and atrial flutter who are hemodynamically
stable.
IIa B-NR Atrial pacing can be effective for acute treatment in ACHD
patients and SVT who are hemodynamically stable and
anticoagulated as per current guidelines for antithrombotic
therapy in patients with AF.
IIa B-NR Elective synchronized cardioversion can be useful for acute
termination of AT or atrial flutter in ACHD patients when acute
pharmacological therapy is ineffective or contraindicated.
IIb B-NR Oral dofetilide or sotalol may be reasonable for acute treatment
in ACHD patients and AT and/or atrial flutter who are
hemodynamically stable.
25
