Arrhythmia Treatment

Question 1

what is the treatment for sinus bradycardia?

Answer 1

atropine (if acute, e.g. mi)

pacing if haemodynamic compromise (hypotension, CHF, angina, collapse)

Question 2

what is a drug class that can cause sinus bradycardia?

Answer 2

Beta blockers

Question 3

what is the treatment for sinus tachycardia?

Answer 3

Beta- adrenergic blockers

treat underlying cause

Question 4

what is the treatment for atrial ectopic beats?

Answer 4

there is generally no treatment

B- adrenergic blockers can help

avoid stimulants (caffeine, cigarettes)

Question 5

what is the acute management of supraventricular tachycardia?

Answer 5

vagal manoeuvres: Valsalva manoeuvre, carotid sinus massage

IV adenosine (verapamil is an alternative)

Question 6

what is used to treat acute stable SVT patients in which vagal/ drug treatments have failed?

Answer 6

DDCV - direct current cardioversion

Question 7

which drugs are used in acute SVT?

Answer 7

IV adenosine
IV verapamil

Question 8

how does adenosine work?

Answer 8

slows cardiac conduction primarily through AV node

It interrupts the AV node / accessory pathway during SVT and ‘resets’ it back to sinus rhythm

Question 9

what is the first line treatment in chronic SVT management for the young/symptomatic patients?

Answer 9

electrophysiological study
radiofrequency ablation

Question 10

what are chronic managements of SVT?

Answer 10

avoid stimulants
Beta Blockers
Antiarrhythmic drugs
Electrophysiologic study and Radiofrequency ablation (first line in young, symptomatic patients)

Question 11

what is long term management of patients with paroxysmal SVT?

Answer 11

medication- beta blockers, CCB or amiodarone
radiofrequency ablation- preferred in younger patients

Question 12

what is the treatment for atrioventricular block?

Answer 12

pacemaker

Question 13

how is unstable VT with a pulse managed?

Answer 13

DDCV (direct current cardioversion)

Question 14

how is pulseless VT managed?

Answer 14

defibrillation

Question 15

how is stable ventricular tachycardia managed?

Answer 15

First line: anti-arrhythmic drugs : amiodarone or lignocaine
DDCV if medical treatment fails

Question 16

what is given for stable VT if medical treatment fails?

Answer 16

DDCV

Question 17

if you are unsure if it is VT or something else, what should be used to make a diagnosis?

Answer 17

adenosine

because adenosine should not have effect on ventricular arrhythmias

Question 18

which anti arrhythmic drugs should be used for VT?

Answer 18

Anti-arrhythmic drugs to date have been shown to be ineffective and are associated with worse outcomes

Question 19

what is long term treatment for ventricular tachycardia?

Answer 19

correct ischaemia if possible- revascularisation
if life threatening: ICD- implantable cardioverter defibrillator
VT catheter ablation

Question 20

can both VT and VF be defibrillated?

Answer 20

yes

Defibrillation or unsynchronized cardioversion is indicated in any patient with pulseless VT/VF or unstable polymorphic VT, where synchronized cardioversion is not possible

Question 21

what is the management for VF?

Answer 21

defibrillation
cardiopulmonary resuscitation
long term- ICD

Question 22

what is long term VT treatment?

Answer 22

ICD- implantable cardioverter-defibrillator

Question 23

if AF is causing heart failure should B-blockers be used?

Answer 23

no

Question 24

what are options for rate control in AF?

Answer 24

1. β-blocker e.g. atenolol is first line
2. CCB e.g. diltiazem (not preferable in heart failure), verapamil (NOT OTHER CCBs)
3. Digoxin (increases vagal tone) (only in sedentary people, needs monitoring and risk of toxicity)

alone or cautiously in combination

• Other: AV node ablation

Question 25

is rate or rhythm control given in AF when it is causing heart failure? what is the treatment?

Answer 25

Rhythm

Cardioversion - immediate if AF present <48 hrs or severely haemodynamically unstable
delayed cardioversion if if AF present for more than 48 hours and patient is haemodynamically stable

Question 26

which drugs are used in pharmacological cardioversion for AF?

Answer 26

anti-arrhythmic drugs: amiodarone, flecanide

Question 27

how long should patients be anticoagulated before cardioversion?

Answer 27

minimum 3 weeks

Question 28

what are long term managements for AF?

Answer 28

• β-blocker
• Dronedarone is second line for maintaining normal rhythm where patients have had successful cardioversion
• Amiodarone is useful in patients with heart failure or left ventricular dysfunction
• Others: left atrial catheter ablation, Maze procedure

Question 29

what is the aim of electrical cardioversion?

Answer 29

immediate restoration of sinus rhythm

Question 30

name class 3 drugs, what do they do?

Answer 30

amiodarone
soltalol
dronedarone

prolong action potential

Question 31

name class 1 drugs that reduce Na channel current

Answer 31

lignocaine
quinidine
flecainide
propafenone

Question 32

is SAN or AVN ablated to stop fast conduction to the ventricles?

Answer 32

AVN

Question 33

what is given long term to AF patients to prevent thromboembolic complications?

Answer 33

Warfarin
DOACs

Question 34

which medications should be avoided in long QT?

Answer 34

anti depressants
antibiotics
antihistamines

Question 35

what is long term management of congenital QT?

Answer 35

Beta blockers
avoidance of triggers
correction of electrolyte abnormalities (maintenance of serum K at upper limit of normal range)
pacemaker therapy
avoid QT prolonging drugs