As such, the merit of flecainide as pill in the pocket for outpatient therapy for AVNRT remains unclear. IIa B-NR Clinical follow-up without pharmacological therapy or ablation is reasonable for ongoing management in minimally symptomatic patients with AVNRT.244 See Online Data Supplement 10. In a prospective study of 93 adult patients with AVNRT who were followed for approximately 15 years, nearly half of minimally symptomatic patients who received no therapy (versus ablation or antiarrhythmic agents) improved over time and became asymptomatic.244 Patients with a confirmed or suspected diagnosis of AVNRT who choose not to undergo catheter ablation or take medications should be educated about when to seek medical attention and be taught how to perform vagal maneuvers. IIb B-R Oral sotalol or dofetilide may be reasonable for ongoing management in patients with AVNRT who are not candidates for, or prefer not to undergo, catheter ablation.107,114 See Online Data Supplement 9. Unlike flecainide and propafenone, sotalol and dofetilide can be used in patients with structural heart disease or coronary artery disease.113 Given the potential for significant QT prolongation and torsades de pointes, inpatient monitoring with serial ECGs is generally performed when these agents are initiated. Generally, these agents are reserved for patients who are unresponsive to, or are not candidates for, beta blockers, diltiazem, flecainide, propafenone, or verapamil. IIb B-R Oral digoxin or amiodarone may be reasonable for ongoing treatment of AVNRT in patients who are not candidates for, or prefer not to undergo, catheter ablation.99,115 See Online Data and 10. 