Treatment of orthodromic tachycardia

Author Ольга Кияница


Paroxysmal tachycardias include orthodromic tachycardia, which is clinically no different from other forms of rapid heart palpitations. Diagnosis of the disease is carried out by means of ECG and electrophysiological research, after which the treatment tactics are chosen.

The orthodermic tachycardia may develop with the use of explicit and hidden paths for impulses. The latter are difficult to determine using electrocardiography, therefore, other diagnostic methods are selected based on the type of mapping of the electrical activity of the atrium.

In WPW syndrome, orthodromic tachycardia occurs in 70-80% of cases.In the fifth part of the patients the presented pathology is combined with paroxysmal atrial fibrillation.

In most cases, the predictive value is favorable. According to various studies, sudden death from orthodromic tachycardia and similar rhythm disturbances occurs in 0.1% of cases. Therefore, it is important that you contact your doctor in time and go through the prescribed course of treatment.

Video Therapeutic drugs for tachycardia

Medicinal treatment of orthodromic tachycardia

In the beginning, sinus rhythm is restored. For this purpose, first of all, a Valsalva test is used in the form of straining the muscles of the abdominal press or stroke after the inspiration. Also carotid sinus massage helps. If there is a possibility, a reflex of diving is performed, for which the face is immersed in cold water for up to 10 seconds. According to various data, weighty tests help stop the attack in 50-90 out of 100 cases.

Failure to carry out weight loss should be replaced by the use of antiarrhythmic drugs. Start with the introduction of adenosine (ATP), in some cases verapamil is initially introduced, but then blood pressure should be monitored.

Adenosine has a rapid effect in 90% of cases. The only thing that is often the side effects of receiving it. The most commonly occurring:

  • redness of the face;
  • the appearance of a feeling of lack of air;
  • the appearance of headache;
  • may become "bad".

Subjective discomfort from adenosine administration takes about 30 seconds.


Exemplary efficacy of other drugs during paroxysm shrinkage:

  • 80% - aimalin, he is a hyulitrim
  • 50% - obsidian and novocainamide;
  • 30% digoxin.

Diagrams of use of antiarrhythmic drugs, for the relief of attacks are diverse. But the American Cardiology Association for the registration of wide ventricular complexes recommends the following drug introduction:

  1. Lidocaine
  2. ATP
  3. Novokainamide
  4. Cordaron

For variants of tachycardia with narrow complexes, the following drug administration regimen is often used: intravenously ATP or verapamil - intravenous novocainamide or rhythmilene - intravenous amiodarone.

Ineffective drug therapy is an indication of conducting electrical pacemakers. In difficult cases, a CSF is used.

Radiofrequency catheter destruction

Refers to radical methods of treating orthodermic tachycardia. Can be used right after the paroxysm is cut off. In view of the fact that, with the multiplicity of hidden paths, it is quite difficult to conduct qualitative destruction. Therefore, the effectiveness of the method in orthodermic tachycardia is approximately 90%.


Before conducting radiofrequency ablation, an electrophysiological examination is obligatory. With the help of this method, the probability of other paroxysmal disturbances of the rhythm is excluded. Also, you get additional information about the localization of hidden paths.

If after the RFA repeated attacks of orthodromic tachycardia occur, then an open heart operation is performed or antiarrhythmic drugs are prescribed for long-term administration.

Video Catheter ablation at arrhythmias

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