Acute management of paroxysmal atrioventricular junctional reentrant supraventricular tachycardia: Pharmacologic strategies

Sami Viskin, Bernard Belhassen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)180-188
Number of pages9
JournalAmerican Heart Journal
Issue number1
StatePublished - Jul 1990


Dive into the research topics of 'Acute management of paroxysmal atrioventricular junctional reentrant supraventricular tachycardia: Pharmacologic strategies'. Together they form a unique fingerprint.

Cite this