Le traitement préventif de choix repose sur les bétabloquants (dose unique ou imprégnation au long cours), sinon le vérapamil (sauf contre-indication cardiologique) et/ou les antiarythmiques de classe I (tachycardie rebelle).
Le traitement des formes invalidantes fait appel aux méthodes ablatives (ex. radiofréquence ou cryothérapie).
PROPHYLACTIC ANTIARRHYTHMIC TREATMENT OF AVNRT
Catheter ablation is recommended as the treatment of choice after a first recurrence related to the high success rate, low risk for AV block (,1%), and low recurrence rate after ablation (,2%). Prophylactic antiarrhythmic drug treatment is effective in approximately 30–50%, and may burden the quality of life more than the arrhythmia itself, if episodes are infrequent. In patients with recurrent episodes of AVNRT, unresponsive to AV nodal blocking agents, and who prefer antiarrhythmic drug treatment, class IC drugs can be particularly effective due to their use dependent effect on the retrograde fast pathway. Flecainide (200–300 mg/day) prevented the recurrence of AVNRT in 65% of patients and appears to have greater long term efficacy than verapamil. Several double blind, placebo controlled trials have confirmed the efficacy of both flecainide and propafenone for prevention of recurrences. Limited prospective data are available for use of class III drugs (for example, amiodarone, sotalol, dofetilide), even though many have been used effectively to prevent recurrences.