Acute management of paroxysmal atrioventricular junctional reentrant supraventricular tachycardia: pharmacologic strategies.
A vast array of effective antiarrhythmic agents offers the attending physician attractive options for termination of PJRT. Calcium channel blockers, adenosine compounds, amjaline, and the newer drugs flecainide and propafenone offer an efficacy rate of more than 80% for acute termination of PJRT. Choice should be based on the patient's clinical characteristics including any underlying cardiac or noncardiac pathologic conditions, hemodynamic status, and current medications. Drugs with a very short half-life (adenosine compounds) offer the possibility of repeated administration at increasing dosages or of subsequent administration of a second antiarrhythmic drug without fear of increased adverse effects or drug interactions. Drugs with a long half-life, such as calcium channel blockers, flecainide, and propafenone, have the potential advantage of preventing an immediate recurrence of the arrhythmia. Adenosine compounds are the fastest acting drugs, resulting in termination of PJRT in less than 30 seconds. The cardiac side effects of all antiarrhythmic drugs represent an exaggeration of their intrinsic electrophysiologic and hemodynamic effects. Thus hemodynamic decompensation and bradyarrhythmias resulting from sinus nodal, AV nodal, or infranodal dysfunction are of major concern. Side effects of adenosine compounds are extremely common but very short lasting. Verapamil is both highly effective and safe except in very special circumstances. Guidelines for therapy of PJRT in specific groups of patients are provided.
Department of Cardiology, Tel Aviv Medical Center, Ichilov Hospital, Israel.
S
S
Viskin
B
B
Belhassen
D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000188:drug therapy*; D013617:Tachycardia, Supraventricular / Q000188:drug therapy*
D000889:Anti-Arrhythmia Agents