Ongoing Management: Recommendations Recommendations for Ongoing Management of AVNRT COR LOE Recommendations I B-R Oral verapamil or diltiazem is recommended for ongoing management in patients with AVNRT who are not candidates for, or prefer not to undergo, catheter ablation.98,99,243,244 See Online Data and 10. Both diltiazem and verapamil are well-tolerated and effective pharmacological alternatives to ablation for the ongoing treatment of patients When therapy with these agents is initiated, attention should be directed toward avoiding the potential for bradyarrhythmias and hypotension. Diltiazem and verapamil should also be avoided in patients with systolic heart failure. I B-NR 2. Catheter ablation of the slow pathway is recommended in patients with AVNRT.36,100 106,245 249 See Online Data and 10. Catheter ablation of AVNRT is regarded as first-line therapy for treatment of symptomatic AVNRT. It is potentially curative, and chronic pharmacological therapy is usually not needed after the procedure. Slow-pathway ablation (also called modification) is the preferred target during ablation of AVNRT. Large registry studies report the success rates of slow-pathway ablation to be >95%, with a <1% risk of AV block (Table 8).36,100 102,246 248 Cryoablation of AVNRT is an alternative to radiofrequency ablation. 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. 