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Stable Narrow-Complex Tachycardia
Flowchart
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Vagal → adenosine → rate control.
Decision
Outcome
Decision
Stable narrow-complex tachycardia. First maneuver?
✓
Vagal maneuvers (carotid sinus massage, Valsalva, modified Valsalva)
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Cardioversion
Decision
Rhythm regular?
✓
Regular → adenosine 6 mg → 12 mg if no response
✓
Irregular → rate control (diltiazem, β-blocker) for AF/aflutter
Decision
Response to adenosine?
✓
Sinus rhythm restored → likely AVNRT/AVRT
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Atrial activity unmasked → atrial flutter or AT
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No response → consider expert consultation, β-blocker, CCB
Outcome
Long-term: catheter ablation; β-blocker or CCB for maintenance
Outcome
Anticoagulation per CHA₂DS₂-VASc; ablation often curative
Outcome
Cardiology consult
Outcome
Rate control + anticoagulation if AF with CHA₂DS₂-VASc ≥2 (men) or ≥3 (women)
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