What are the AHA/ACC/HRS treatment guidelines for orthodromic atrioventricular reentrant tachycardia (AVRT) 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

For management of ongoing orthodromic AVRT, the guidelines recommend catheter ablation of the accessory pathway.(class I; level of evidence,  B-R) Patients with preexcitation resting ECG who are not candidates or prefer not to undergo catheter ablation have the following alternative treatment options:

  • Flecainide or propafenone in patients without structural heart disease or ischemic heart disease (class IIa; Level of evidence B-R)
  • Sotalol or dofetilide (class IIb; level of evidence, B-R)
  • Oral beta blockers, diltiazem, verapamil (class IIb; level of evidence,  C-LD)
  • Oral amiodaronewhen other therapies are ineffective or contraindicated (class IIb; level of evidence, C-LD)
  • Oral digoxin is potentially harmful for ongoing management in patients with AVRT or AF and preexcitation on their resting ECG (class III; level of evidence, C-LD)

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