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Description Sales organization Distribution channel Division Sales document type Pricing procedure Description Sold to party Sales office Sales group Pricing date Document date Order reason Document currency Price group Sales district Customer group Shipping condition Incoterms Payment terms

025 mg/kg over 2 min; second 035-mg/kg bolus after 15 min if response is inadequate; infusion rate, 5 15 mg/h 6 mg rapidly followed by 12 mg after 1 2 min if needed; use half these doses if administered via central line 05 mg over 20 min followed by increment of 025 or 0125 mg to 1 15 mg over 24 h

Miscellaneous: Indications: Supraventricular tachycardia Adenosine Adenosine receptor stimulation, metabolized in blood Transient flushing, dyspnea, chest pain, AV block, sinus bradycardia; effect by theophylline, by dipyridamole AV block, arrhythmias, GI, visual changes

AV, atrioventricular; CNS, central nervous system; Dig, elevation of serum digoxin level; GI, gastrointestinal (nausea, vomiting, diarrhea); LVF, reduced left ventricular function; NAPA, N-acetylprocainamide; SLE, systemic lupus erythematosus; VT, ventricular tachycardia

calcium channel blockers, such as diltiazem and verapamil, or -blockers are typically used first For patients with heart failure, digoxin can be effective as initial treatment Patients who do not respond to agents that increase refractoriness of the AV node may be treated with antiarrhythmics The class Ic agents (flecainide, propafenone) can be used in patients without underlying structural heart disease In patients with evidence of structural heart disease, class III agents, such as sotalol or amiodarone, are probably

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a better choice because of the lower incidence of ventricular proarrhythmia during long-term therapy

Blomstrom-Lundqvist C et al; European Society of Cardiology Committee, NASPE-Heart Rhythm Society ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias executive summary A report of the American College of Cardiology/American Heart Association task force on practice guidelines and the European Society of Cardiology committee for practice guidelines (writing com-

mittee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society J Am Coll Cardiol 2003 Oct 15;42(8):1493 531 [PMID: 14563598] Chauhan VS et al Supraventricular tachycardia Med Clin North Am 2001 Mar;85(2):193 223 [PMID: 11233946] Hebbar AK et al Management of common arrhythmias: Part I Supraventricular arrhythmias Am Fam Physician 2002 Jun 15;65(12):2479 86 [PMID: 12086237]

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They should be advised to report the onset of any of these symptoms Patients found incidentally to have delta waves who have jobs that could potentially put others at risk (ie, pilot, bus driver, etc) may need to undergo electrophysiologic testing with possible catheter ablation to ensure that they are not at risk for sudden death

As with AVNRT, radiofrequency ablation has become the procedure of choice in patients with accessory pathways and recurrent symptoms Patients with preexcitation syndromes who have episodes of atrial fibrillation or flutter should be tested by induction of atrial fibrillation in the electrophysiologic laboratory, noting duration of the RR cycle; if it is less than 220 ms, a short refractory period is present These individuals are at highest risk for sudden death, and prophylactic ablation is indicated Success rates for ablation of accessory pathways with radiofrequency catheters exceed 90% in appropriate patients

SUPRAVENTRICULAR TACHYCARDIAS DUE TO ACCESSORY AV PATHWAYS (PREEXCITATION SYNDROMES) General Considerations

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