Recent systematic reviews and trials randomizing patients to radiofrequency ablation versus cryoablation suggest an equivalent acute success rate, with a lower rate of AV block but a higher rate of recurrence during I B-R Oral beta blockers are recommended for ongoing management in patients with AVNRT who are not candidates for, or prefer not to undergo, catheter ablation.99 See Online Data Supplement 9. Evidence for oral beta blockers is limited. One small study randomized patients with AVNRT and AVRT to digoxin (0.375 mg/day), propranolol (240 mg/day), or verapamil (480 mg/day), with 1 week of placebo washout between drug regimens.99 Episodes and duration of tachyarrhythmia (ascertained by diary and weekly 24-h Holter) were similar among the treatment groups, and all 3 medications were well tolerated. IIa B-R Flecainide or propafenone is reasonable for ongoing management in patients without structural heart disease or ischemic heart disease who have AVNRT and are not candidates for, or prefer not to undergo, catheter ablation and in whom beta blockers, diltiazem, or verapamil are ineffective or contraindicated.45,46,107 112,114,241,242,250,251 See Online Data and 10. In 1 RCT, the probability of 12 months of effective (defined as <2 attacks of arrhythmia) and safe treatment was 86% for propafenone and 93% for flecainide.109 Flecainide and propafenone have a risk of proarrhythmia in patients with structural heart disease or ischemic heart disease and are contraindicated in these patient groups. In 1 nonrandomized study, flecainide was evaluated as pill-in-the-pocket therapy along with diltiazem or propranolol.241,242 However, all patients were screened with EP studies, and only 5 patients were discharged on flecainide. As such, the merit of flecainide as pill in the pocket for outpatient therapy for AVNRT remains unclear. 