Managing Haemodynamically Stable AVNRT When Drug Therapy Fails to Convert the Tachycardia

In haemodynamically stable patients with atrioventricular nodal re-entrant tachycardia, intravenous drug therapy is initiated first. When that approach does not achieve conversion or control of the arrhythmia, a defined next-line protocol applies.

This protocol is indicated for haemodynamically stable patients with AVNRT — those presenting without signs of haemodynamic instability.

When the Previous Step Has Not Succeeded

The preceding protocol uses intravenous verapamil, diltiazem, or beta-blockers (esmolol or metoprolol) with the goal of achieving conversion or control of the AVNRT. When those agents have not reached that goal, the situation escalates to this protocol.

Next-Line Approach

When drug therapy has not succeeded, the next step involves a targeted electrical intervention. The clinical goal is termination of the AVNRT with restoration of sinus rhythm.

Full procedural criteria and the complete structured regimen are available in the protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehz467

Haemodynamically stable patients.

Synchronized DC cardioversion is recommended when drug therapy fails to convert or control the tachycardia.

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