Haemodynamically Stable AVNRT When Vagal Manoeuvres Have Failed — What Next?

This protocol applies to the acute management of haemodynamically stable atrioventricular nodal re-entrant tachycardia (AVNRT) in patients who have already undergone a first-line attempt that did not restore normal rhythm.

Clinical scenario

The patient presents with haemodynamically stable AVNRT — no haemodynamic instability is present. This is the key criterion that defines both the initial and escalated approach.

Previous line — failure condition

Vagal manoeuvres (preferably performed in the supine position with leg elevation) were applied as the first-line intervention. The target goal — termination of the atrioventricular nodal re-entrant tachycardia — was not achieved. This protocol is the recommended next step following that failure.

Next-line approach

When vagal manoeuvres are unsuccessful, the evidence supports escalation to an intravenous pharmacological intervention. The specific agent, dosing, and administration protocol are detailed in the full structured regimen below.

Treatment goal

Termination of the atrioventricular nodal re-entrant tachycardia.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehz467

Haemodynamically stable patients

Adenosine (6-18 mg i.v. bolus) is recommended if vagal manoeuvres fail.

View source ↗