Non Pharm Management Cardiac Arrhythmias

Question 1

What are the types of tachycardia?

Answer 1

• Ventricular = life-threatening

- Supraventricular = non-life threatening

Question 2

If there is a distinctive narrow complex tachycardia, what is it likely to be?

Answer 2

AF
Atrial flutter
MAT

Question 3

If there is a narrow complex tachycardia with a short RP, what is it likely to be?

Answer 3

P wave buried in QRS or just after QRS

AVNRT
AVRT

Question 4

If there is a narrow complex tachycardia with a long RP, what is it likely to be?

Answer 4

P wave precedes QRS

Sinus Tachycardia
Atrial Tachycardia

Question 5

What is AVNRT?

Answer 5

Input 1 > AVN > Ventricles > Back up to AVN through input 2 (re-entrance circuit = slow pathway)

Question 6

What is AVRT?

Answer 6

Accessory pathway

Down AVN > Short circuits from ventricle > Atrium (macro re-entrance circuit)

Question 7

How do you relieve symptoms of AVN dependent tachycardia?

Answer 7

• Teach valsalva manoeuvre
• Lifestyle modification
• A&E infrequently for dose of adenosine
• Drugs during systematic periods (B blocker)
• Regular drugs to prevent future attacks (AV blocking drug)
• Curative ablation dor adenosine sensitive tachycardias

Question 8

What is first line treatment of AVN dependent tachycardia?

Answer 8

• Radiofrequency ablation
• Femoral vein access
• Slow pathway modification - modify one of the inputs into AVN
• Accessory pathway - burn bit of muscle to break pathway
• Quick recovery

Question 9

What is seen on a WPW ECG?

Answer 9

• Short PR interval
• Delta waves
• Abnormal Q waves

Question 10

What is WPW syndrome?

Answer 10

• AF + WPW ECG = risk of degenerating into VF

- 1st line treatment = ablation

Question 11

What is the management of AF?

Answer 11

1. Identify + treat underlying cause
   - Recurrent: hypertension, cardiomyopathy, valvular HD
   - 1st presentation: PE, thyrotoxicosis, pneumonia, binge drinking
2. Prevent stroke - CHADVASC
3. Relieve symptoms - rhythm + rate control

Question 12

Who should be offered life long anticoagulation?

Answer 12

Recurrent AF + CHADVASC >= 1

Except females with CHADVASC = 1

Question 13

What is the treatment for AF?

Answer 13

Pulmonary vein isolation (PVI)

For highly symptomatic AF patients who have failed at least 1 anti-arrhythmic drug

Question 14

Describe the difference between the use of PVI and pace+ablate?

Answer 14

PVI

• Younger patients
• Paroxysmal AF
• Restores SR
• Major complications inc stroke + tamponade

Pace + ablate

• Older patients
• Permanent AF
• Prevents symptoms due to rapid or irregular rhythms
• Ongoing symptoms due to loss of AV synchrony PPM issues

Question 15

Summarise the management of tachycardias

Answer 15

• Ablation
• AVN blockers
• Anti-arrhythmic drugs
• DC cardioversion