How is narrow-complex atrioventricular (AV) reentrant tachycardia (AVRT) treated in Wolff-Parkinson-White (WPW) syndrome?

Updated: Jan 08, 2017
  • Author: Christopher R Ellis, MD, FACC, FHRS; Chief Editor: Mikhael F El-Chami, MD  more...
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Answer

It should be treated in the same way as AV nodal reentrant tachycardia (AVNRT), by blocking AV node conduction with (1) vagal maneuvers (eg, Valsalva maneuver, carotid sinus massage, splashing cold water or ice water on the face), (2) IV adenosine 6-12 mg via a large-bore line (the drug has a very short half-life) in adults, or (3) IV verapamil 5-10 mg or diltiazem 10 mg in adults. In pediatric patients, adenosine and verapamil or diltiazem dosing regimens are weight-based.

Both adenosine and calcium channel blockers have been reported to result in atrial fibrillation with rapid, preexcited atrial fibrillation eventuating in ventricular fibrillation; therefore, close monitoring during administration of these agents is essential, and cardioversion equipment and medications must be immediately available. Use of adenosine is preferred due to its short duration of action.


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