This protocol covers the acute management of orthodromic atrioventricular re-entrant tachycardia (AVRT) in patients who remain haemodynamically stable.
The patient presents with orthodromic AVRT and is haemodynamically stable. This stable clinical status determines the approach: a stepwise pharmacological strategy is followed, progressing through specific agents if earlier steps do not restore sinus rhythm.
The protocol involves intravenous agents from two pharmacological classes. The choice between them — and whether one class is excluded — is governed by the patient's cardiac function. The complete selection criteria, agent sequence, and decision thresholds are contained in the full structured protocol.
In orthodromic AVRT, adenosine (6-18 mg i.v. bolus) is recommended if vagal manoeuvres fail and the tachycardia is orthodromic.
In orthodromic AVRT, i.v. verapamil or diltiazem should be considered if vagal manoeuvres and adenosine fail.
In orthodromic AVRT, i.v. beta-blockers (esmolol or metoprolol) should be considered in the absence of decompensated HF, if vagal manoeuvres and adenosine fail.
DOI: 10.1093/eurheartj/ehz467
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