Atrioventricular Nodal Reentrant Tachycardia (AVNRT)


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  • Type of supraventricular tachycardia (SVT) characterized by AV-nodal reentry
    • Both pathways reside within the AV node


  • Narrow-Complex Regular Tachycardia: usual manifestation
    • Rate: usually >150
    • Typical abrupt onset and termination
    • Absence of readily identifiable p-waves
  • Wide-Complex Regular Tachycardia: may be seen in cases with pre-existing bundle branch block or in cases with reta-related aberrant conduction


  • Stable: agents that inhibit AV nodal conduction
    • Vagal Maneuvers (Carotid Massage, Valvsalva): when used alone, will terminate SVT’s in 25% of cases
    • Adenosine
      • Initial 6 mg via peripheral IV, followed by 20 ml flush
      • Subsequent 6 mg via peripheral IV, followed by 20 ml flush
      • Use initial dose 50% less if CVC, heart transplant, carbamazepine, dipyridamole
      • Antagonized by theophylline, theobromine, or caffeine
      • Side Effects: flushing, dyspnea/bronchospasm, chest discomfort
      • Contraindications: asthma
      • Pregnancy: safe
    • Beta Blockers
    • Calcium Channel Blockers
    • Digoxin: less desirable
    • Amiodarone
      • Slower effect than adenosine
      • Less desirable than AV nodal blockers in AVRT
  • Unstable
    • Synchronized cardioversion 50-100 J


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