This protocol addresses Wolff-Parkinson-White syndrome presenting as orthodromic atrioventricular re-entrant tachycardia (AVRT) when the patient remains haemodynamically stable — a specific scenario that calls for a defined pharmacological approach.
Clinical scenario: Orthodromic AVRT with no haemodynamic instability. The rhythm is sustaining via a re-entrant circuit, and pharmacological termination — with agent choice tailored to the patient's cardiac status — is the indicated strategy.
The evidence-based approach involves intravenous calcium-channel blockers or, in appropriately selected patients, intravenous beta-blockers — the full protocol specifies which agents apply, the patient-selection criteria, and how agent choice is sequenced.
DOI: 10.1093/eurheartj/ehz467
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.
View source ↗