Oral diltiazem or verapamil is reasonable for ongoing management in patients with junctional tachycardia.397 See Online Data Supplement 19. Junctional tachycardia caused by enhanced automaticity may be suppressed as effectively by diltiazem and verapamil as by beta blockers. In 1 study of an adult patient on a regimen of oral verapamil, procainamide, and digoxin in combination for prophylactic therapy, junctional tachycardia could not be induced by either atrial or ventricular overdrive pacing, programmed electrical stimulation, or isoproterenol.397 Less is known about oral diltiazem than verapamil, but it likely has a similar efficacy. IIb C-LD Flecainide or propafenone may be reasonable for ongoing management in patients without structural heart disease or ischemic heart disease who have junctional tachycardia.398,399 See Online Data Supplement 19. Studies supporting the use of flecainide for long-term control of junctional tachycardia were performed at a time when intravenous flecainide was given for acute control, followed by a transition to chronic oral therapy.398 Although the only data for propafenone stem from case series in infants and children, given that flecainide and propafenone reduce automaticity from the ectopic focus in the AV junction, either agent is reasonable, provided patients do not have structural heart disease or ischemic heart disease.213,400,401 IIb C-LD Catheter ablation may be reasonable in patients with junctional tachycardia when medical therapy is not effective or See Online Data Supplement 19. Radiofrequency ablation has been performed as a potentially curative therapy for junctional tachycardia since the early 1990s. However, in view of the reported 5% to 10% risk of AV block, catheter ablation is generally reserved for highly symptomatic patients in whom drug therapy has been ineffective or not tolerated (Table 8). 