From the Guidelines
Multiple events atrial tachycardia should be initially managed with vagal maneuvers, such as the Valsalva maneuver or carotid sinus massage, as recommended by the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1.
Initial Management
- Vagal maneuvers, including Valsalva and carotid sinus massage, can be performed quickly and should be the first-line intervention to terminate supraventricular tachycardia (SVT) 1.
- The Valsalva maneuver involves raising intrathoracic pressure by bearing down against a closed glottis for 10 to 30 seconds, equivalent to at least 30 to 40 mm Hg 1.
- Carotid massage is performed after absence of bruit has been confirmed by auscultation, by applying steady pressure over the right or left carotid sinus for 5 to 10 seconds 1.
Pharmacological Therapy
- If vagal maneuvers are ineffective, adenosine is beneficial for acute treatment in patients with orthodromic AVRT, with a success rate of 90% to 95% 1.
- Adenosine may precipitate atrial fibrillation (AF) that may then conduct rapidly to the ventricle and even cause ventricular fibrillation, so electrical cardioversion should be available 1.
- For hemodynamically stable patients with AVRT, synchronized cardioversion is recommended when pharmacological therapy is ineffective or contraindicated 1.
Cardioversion and Antiarrhythmic Drugs
- Synchronized cardioversion is highly effective in terminating AVRT and should be considered early in the management of hemodynamically unstable patients 1.
- Antiarrhythmic drugs, such as ibutilide or intravenous procainamide, may be required to prevent acute reinitiation of tachycardia after cardioversion 1.
- For patients with pre-excited AF, synchronized cardioversion is highly effective in terminating the arrhythmia, and ibutilide or intravenous procainamide may be beneficial for acute treatment in hemodynamically stable patients 1.
From the FDA Drug Label
The acute effectiveness of amiodarone HCl injection in suppressing recurrent VF or hemodynamically unstable VT is supported by two randomized, parallel, dose-response studies of approximately 300 patients each In these studies, patients with at least two episodes of VF or hemodynamically unstable VT in the preceding 24 hours were randomly assigned to receive doses of approximately 125 or 1000 mg over the first 24 hours, an 8-fold difference.
Multiple Events Atrial Tachycardia is not directly addressed in the provided drug labels. The FDA drug label does not answer the question.
From the Research
Multiple Events Atrial Tachycardia
- Atrial tachycardia (AT) is a type of arrhythmia that can occur after multiple catheter ablation (CA) procedures for atrial fibrillation (AF) and other tachyarrhythmias 2.
- The definition of "multiple" ablations is not well-established, and it is unclear whether atrial tachyarrhythmias that occur post-ablation are due to the proarrhythmic effects of CA or a continuum of the arrhythmia spectrum from the underlying atriopathy 2.
- High-density three-dimensional electroanatomic mapping can be used to accurately identify arrhythmia mechanisms and elucidate the disease substrate in patients with prior multiple CAs 2.
- Radiofrequency ablation can be effective in terminating AT and achieving bidirectional conduction block across the line, resulting in significant clinical improvement 2.
- Beta-blockers, such as metoprolol succinate, may be used to reduce new incidents of AF in high-risk patients and are associated with significant mortality and morbidity benefits in the treatment of heart failure (HF) 3.
Treatment Options
- Anti-arrhythmic drugs, such as beta-blockers, may be used to treat AT and other tachyarrhythmias 3.
- Additional ablation procedures may be necessary for patients who have undergone multiple CAs and continue to experience symptomatic and drug-refractory AT/AFL 2.
- High-density mapping and radiofrequency ablation can be used to restore sinus rhythm and improve clinical outcomes in patients with prior multiple CAs 2.