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Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common regular, sustained paroxysmal supraventricular tachycardia. AVNRT affects mainly young and middle-aged otherwise healthy adults. An electrophysiology study is mandatory to definitively diagnose and differentiate this arrhythmia from other supraventricular tachycardias with similar electrocardiographic features. Catheter ablation is currently the best therapeutic option for symptomatic patients, and while not without risk, it is generally very well-tolerated. This activity reviews the role of electrophysiology study and catheter ablation in the diagnosis and treatment of AVNRT and highlights the role of the healthcare team in the management of patients with this arrhythmia. Objectives: Describe the anatomical and physiological substrate of the AV nodal reentrant tachycardia mechanism. Effectively counsel patients with AV nodal reentrant tachycardia about the indications, contraindications, risks, benefits, complications, and outcomes of radiofrequency ablation and cryoablation for the treatment of this dysrhythmia. Apply best practices when performing an electrophysiology study on patients with AV nodal reentrant tachycardia. Develop and implement effective interprofessional team protocols to improve outcomes for patients with AV nodal reentrant tachycardia undergoing electrophysiology evaluation and catheter ablation. Access free multiple choice questions on this topic.

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of regular supraventricular tachycardia and is routinely treated with catheter ablation (CA). AVNRT most commonly affects young and middle-aged otherwise healthy adults; females are more frequently affected than males.[1][2] AVNRT is characterized by a reentrant circuit involving fast and slow pathways near the compact AV node; the ventricles do not participate in the tachycardia circuit. Although the exact location of this circuit remains elusive, specific anatomical landmarks have been used successfully to guide arrhythmia treatment with CA over the past 25 years.[3] Differentiating AVNRT from other supraventricular tachycardias can be challenging and often requires specific pacing maneuvers during an electrophysiology study.[4] This activity will address the main features of the electrophysiological diagnosis and ablation therapy of AVNRT.

Although CA of AVNRT is considered a safe procedure, it carries a low but definite risk of AV block, which may require immediate or late implantation of a permanent pacemaker.[66] AV block can affect 1 to 2.3% of patients after slow pathway ablation.[67] Ablation of the fast pathway has been associated with a significantly higher risk of AV block; this procedure is reserved for patients with a PR prolongation suggestive of poor antegrade fast-pathway conduction.[68] Other complications, including vascular access complications, cardiac perforation, tamponade, bleeding, or thromboembolic events, are rare.[69] A recent meta-analysis showed that all-cause mortality from ablation of supraventricular tachycardia is as low as 0.1%, while the rate of adverse events was 2.9%.[70]

Expertise in arrhythmia management is essential for accurately diagnosing and effectively treating AVNRT. Primary care practitioners, clinical cardiologists, and electrophysiologists play critical roles in decision-making before and after the procedure. Team involvement of allied healthcare professionals is equally important. Registered nurses, advanced practice providers, and cardiovascular technicians should receive training in managing complex arrhythmias. The primary electrophysiologist performing the diagnostic and therapeutic procedures must possess the qualifications and skills to ensure safe and efficient treatment. The electrophysiologist is also accountable for educating junior clinicians involved in the procedure, dedicating adequate time to coordinating teamwork, and effectively communicating important information about procedural strategy and preprocedural and postprocedural care. Informed consent must be obtained, and all team members are responsible for effective communication within the team and with the patient. The involvement of an anesthesiologist in AVNRT ablation is typically minimal, as conscious sedation or general anesthesia is rarely required. However, the anesthesia team must be readily available and provide educational support to the clinical staff administering sedative agents. Advanced practice providers actively participate in patient care before and after CA. During the procedure, the clinical nursing staff diligently monitors the patient and promptly responds to any emergencies that may arise. Electrophysiology technicians ensure equipment function, resolve technical issues, and potentially operate the recording system and stimulator. Primary care practitioners play a crucial role in providing the electrophysiology team with feedback on the long-term effects of the CA, possible recurrences of AVNRT, and advancements in the quality of life of the patient. A multidisciplinary team approach is essential to ensure procedural success and patient safety. Consistent training and adaptation to evolving technology, effective communication, strategic planning, and quality evaluation are crucial for achieving this objective.[77] [Level 5]