Treatment of Wolff-Parkinson-White Syndrome in Orthodromic Atrioventricular Re-entrant Tachycardia (Haemodynamically Stable Patient)

Clinical Scenario

This protocol addresses Wolff-Parkinson-White (WPW) syndrome when it presents as orthodromic atrioventricular re-entrant tachycardia (AVRT) in a patient who remains haemodynamically stable — that is, without signs of haemodynamic instability. Correct identification of this specific presentation guides the initial management approach.

Key Presentation Criteria

The tachycardia is confirmed as orthodromic AVRT and the patient shows no haemodynamic compromise. This stable status is the deciding factor for the stepwise, non-emergent pathway described in this protocol.

Initial Approach (Overview)

The recommended first step involves vagal manoeuvres to attempt termination of the tachycardia. The full protocol details the recommended technique, positioning, and the structured sequence of subsequent steps.

Complete regimen, decision points, and escalation steps available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

Vagal manoeuvres, preferably in the supine position with leg elevation, are recommended.
In orthodromic AVRT, adenosine (6-18 mg i.v. bolus) is recommended if vagal manoeuvres fail and the tachycardia is orthodromic.

DOI: 10.1093/eurheartj/ehz467

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