Treatment of Antidromic Atrioventricular Reentrant Tachycardia in the Haemodynamically Stable Patient

This protocol covers the stepwise acute management of antidromic AVRT when the patient remains haemodynamically stable — a presentation where preserved circulatory status shapes both the sequence and choice of interventions.

Clinical Scenario

The patient presents with antidromic atrioventricular re-entrant tachycardia and is haemodynamically stable. This combination — the specific tachycardia subtype alongside maintained haemodynamics — determines a structured first-line approach that is distinct from unstable or orthodromic presentations.

Initial Approach (Partial Overview)

The recommended first step is a physical, non-pharmacological manoeuvre performed with the patient in a specific position. The full protocol details what to do next and how to escalate if this initial step does not restore normal rhythm.

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References

DOI: 10.1093/eurheartj/ehz467

Vagal manoeuvres, preferably in the supine position with leg elevation, are recommended.

In antidromic AVRT, i.v. ibutilide or procainamide or i.v. flecainide or profanenone or synchronized DC cardioversion should be considered if vagal manoeuvres and adenosine fail.

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