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Atrioventricular reciprocating tachycardia — Clinical Guidelines

Overview

Atrioventricular reciprocating tachycardia (AVRT), often associated with Wolff-Parkinson-White (WPW) syndrome, involves reentry circuits utilizing an accessory pathway between atria and ventricles, leading to rapid heart rates. 1 5

Diagnosis

Electrocardiogram (ECG): Identification of delta waves and short PR interval indicative of preexcitation. 1 5

Electrophysiology Study: Confirms accessory pathway location and mechanism of tachycardia. 1 3 5

Entrainment Mapping: Timing of entrainment onset correlates with bypass tract localization. 5

Precorded ECG Analysis: Use of algorithms like St. George's for accessory pathway localization. 3

Management

Radiofrequency Catheter Ablation: Primary treatment targeting the slow pathway in AVNRT or accessory pathway in AVRT. 2 4

Drug Therapy: Beta-blockers or calcium channel blockers for rate control; beta-methyldigoxin ineffective for acute correction. 7

Electrolyte Management: Ensure normal electrolyte levels to avoid arrhythmias. [Expert opinion]

Special Populations

Sex Differences: Females have a higher likelihood of right annular accessory pathways compared to males. 1

Race Considerations: Asians show a higher prevalence of right anterior accessory pathways. 1

Recurrence Risk: Higher recurrence rates noted in anteroseptal, right free-wall, and retrograde-only conducting pathways; lower in left free-wall pathways. 4

Key Recommendations

Perform radiofrequency catheter ablation for definitive treatment of AVRT, targeting the accessory pathway or slow pathway in AVNRT. (Evidence: Strong 2 4)

Utilize electrophysiology studies for precise localization of accessory pathways, enhancing procedural success rates. (Evidence: Moderate 1 3)

Consider sex and racial factors in predicting accessory pathway location to tailor procedural approaches. (Evidence: Moderate 1)

References

1 Hsu JC, Tanel RE, Lee BK, Scheinman MM, Badhwar N, Lee RJ et al.. Differences in accessory pathway location by sex and race. Heart rhythm 2010. link 2 Stühlinger M, Steinwender C, Schnöll F, Winter S, Freihoff F, Wurtz S et al.. GOLDART--Gold Alloy Versus Platinum-Iridium Electrode for Ablation of AVNRT. Journal of cardiovascular electrophysiology 2008. link 3 Xie B, Heald SC, Bashir Y, Katritsis D, Murgatroyd FD, Camm AJ et al.. Localization of accessory pathways from the 12-lead electrocardiogram using a new algorithm. The American journal of cardiology 1994. link90090-6) 4 Twidale N, Wang XZ, Beckman KJ, McClelland JH, Moulton KP, Prior MI et al.. Factors associated with recurrence of accessory pathway conduction after radiofrequency catheter ablation. Pacing and clinical electrophysiology : PACE 1991. link 5 McBride W, Wells PJ, Black WH, Kremers MS. Entrainment onset in atrioventricular reciprocating tachycardia: value in bypass tract localization and relationship to the preexcitation index. Pacing and clinical electrophysiology : PACE 1990. link 6 Benditt DG, Epstein ML, Arentzen CE, Kriett JM, Klein GJ. Enhanced atrioventricular conduction in patients without preexcitation syndrome: relation to heart rate in paroxysmal reciprocating tachycardia. Circulation 1982. link 7 Mahar L, Rowland E, Curry P, Krikler D. Electrophysiological effects soon after intravenous beta-methyldigoxin. European journal of cardiology 1979. link

Atrioventricular reciprocating tachycardia