What is the prognosis and treatment for Atrioventricular Nodal Reentrant Tachycardia (AVNRT)?

From the Guidelines

AVNRT is not typically deadly, and with proper treatment, most patients can lead normal lives. The prognosis for Atrioventricular Nodal Reentrant Tachycardia (AVNRT) is generally excellent, with most patients able to lead normal lives with proper treatment. AVNRT is typically not life-threatening but can significantly impact quality of life if left untreated.

Key Points:

• First-line acute treatment involves vagal maneuvers such as the Valsalva maneuver or carotid sinus massage to terminate an episode, as recommended by the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1.
• If these fail, intravenous adenosine (6-12 mg rapid push) is the medication of choice for acute termination due to its brief AV node blocking effect, with a success rate of approximately 95% 1.
• For long-term management, catheter ablation is considered the definitive treatment with a success rate exceeding 95% and low complication rates (1-2%), as stated in the 2015 ACC/AHA/HRS guideline 1.
• For patients who prefer medical management, antiarrhythmic medications like beta-blockers (metoprolol 25-100 mg twice daily), calcium channel blockers (diltiazem 120-360 mg daily), or class IC antiarrhythmics (flecainide 50-200 mg twice daily) can be effective for prevention, as recommended by the ACC/AHA/HRS guideline 1.
• Patients should be educated about recognizing symptoms and performing vagal maneuvers at home, and regular follow-up is important to assess treatment efficacy and adjust therapy as needed, as emphasized in the guideline 1. However, it is essential to note that while AVNRT itself is not typically deadly, it can lead to more severe complications if left untreated or if underlying heart conditions are present.

Treatment Options:

• Vagal maneuvers: Valsalva maneuver, carotid sinus massage, or other techniques to stimulate the vagus nerve and terminate the arrhythmia 1.
• Adenosine: Intravenous administration to block AV node conduction and terminate the arrhythmia 1.
• Catheter ablation: A minimally invasive procedure to destroy the abnormal electrical pathway in the heart 1.
• Antiarrhythmic medications: Beta-blockers, calcium channel blockers, or class IC antiarrhythmics to prevent recurrences 1. It is crucial to consult a healthcare professional for proper diagnosis and treatment, as they can assess the individual's specific condition and provide personalized recommendations. In general, with proper treatment, most patients with AVNRT can expect complete resolution of symptoms and a significant improvement in their quality of life, as supported by the guidelines and studies 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Prognosis of AVNRT

• AVNRT is a common paroxysmal supraventricular tachycardia among adults, accounting for considerable morbidity 2
• The prognosis for AVNRT is generally good, with a low risk of mortality 3
• However, recurrence of symptoms after successful ablation can occur, with a frequency of around 16% 4

Treatment of AVNRT

• Radiofrequency ablation (RFA) is a highly effective treatment for AVNRT, with a success rate of over 95% 2, 3
• The use of irrigated contact-force sensing RFA catheters has been shown to be safe and effective for AVNRT ablation, with reduced procedure time and risk of atrioventricular block 5
• A high-density mapping-guided slow pathway visualization strategy has also been shown to enhance the safety and effectiveness of RFA for AVNRT, reducing procedure time and minimizing the risk of atrioventricular block 6
• Vagal maneuvers can also be used to disrupt AVNRT in some patients, but RFA is generally considered the definitive treatment of choice 3

Risks and Complications

• The main risk of AVNRT ablation is atrioventricular block, which can occur in around 1-2% of cases 5, 6
• Other potential complications of AVNRT ablation include recurrence of AVNRT, atrial arrhythmias, and sinus tachycardia 4
• A simple clinical score based on age and history of atrial fibrillation can be used to predict the risk of symptom recurrence due to atrial arrhythmias and sinus tachycardia 4