arrhythmia management

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arrhythmia management

arrhythmia management

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  • 1. Management of Arrhythmias Abhishek reddy KMC Manipal
  • 2. Agents classified according to •Mode of action •Site Anti arrhythmic drugs
  • 3. • Acts principally by suppressing excitability and slowing down conduction in atrial or ventricular muscle. • Blocks Na+ channels • Contraindicated in patients w/ heart failure as they depress myocardial function. Class 1 drugs
  • 4. Class 1a drugs: • Prolongs cardiac action potential • ↑ tissue refractory period • Uses: atrial and ventricular arrhythmias • E.g. Disopyramide: • Causes anticholinergic side effects- urinary retention, ppts glaucoma. • Depresses myocardial function n hence avoided in cardiac failure • E.g. Quinidine: • Rarely used as it increases mortality n causes GI upset.
  • 5. Class 1b drugs:  They shorten the AP and tissue refractory period  Acts on ventricles so used in Ventricular tachycardia and ventricular fibrillation.  E.g. Lidocaine, Mexiletine
  • 6. Class 1c  Affects slope of AP w/o altering duration or refractory period.  Uses: prophylaxis of AF, SVA, VA.  Contraindicated in patients w/ previous MI- leads to pro- arrhythmias  E.g. Flecainide  Effective- AF  Given w/ AV node blocking drugs- β blockers to prevent pro-arrhythmias  E.g. Propafenone
  • 7. Class 2 drugs  Group comprises of β blockers  These drugs diminish Phase 4 depolarization, thus depresheart rate and contractility. sing automaticity, prolonging AV conduction, and decreasing  These reduce the rate of SA node depolarization and causes a relative block in AV node.  Uses: Rate control in Atrial Flutter, AF, SVA, VT  Reduces myocardial excitability and risk of arrhythmic death in patients w/ CHD & heart failure.
  • 8.  Cardio selective β blockers:  Acts on myocardial β1 receptors  E.g. Atenolol, Bisoprolol, Metoprolol  Non selective β blockers:  Acts on β1 & β2 receptors  Β2 blockade- bronchospasm and peripheral vasoconstriction  E.g. Propranolol, Nadolol, Carvedilol  Sotalol:  Causes torsade de pointes
  • 9. Class 3 drugs o Acts by prolonging plateau phase of AP. o Hence lengthens refractory period o Effective- atrial & ventricular tachyarrhythmia o Causes QT prolongation and predisposes to torsade de pointes and VT o E.g. Amiodarone o Principal drug o Also has class 1, 2, 4 activity o Most effective drug- paroxysmal AF o Uses: to prevent recurrent episodes of VT o Side effects: photosensitivity, skin discoloration, thyroid dysfunction, nausea, vomiting etc
  • 10. Class 4 drugs  Blocks the slow calcium channels( important for impulse generation and conduction in atrial and nodal tissues  Acts at the AV node  E.g. Verapamil, Diltiazem
  • 11. Other anti- arrhythmic drugs  Atropine Sulphate (0.6 mg i.v., repeated if necessary- maximum of 3 mgs)  ↑ sinus rate and SA, AV conduction  Best choice- severe bradycardia or hypotension due to vagal over activity.  Side effects: dry mouth, thirst, blurred vision, atrial and ventricular extra systoles.
  • 12. Adenosine:  Given i.v. bolus, initially 3mg over 2 sec. If no response after 1-2 mins, 6mg should be given; and if needed after 1-2 mins, max dose 12mg may be given.  Uses: terminate SVT when AV node is part of re-entry circuit or in Atrial Flutter with 2:1 AV block or broad complex tachycardia.  Side effects: flushing, dyspnea, chest pain  Contraindications: Asthma
  • 13. Digoxin  Slows conduction and prolongs refractory period in AV node.  Controls ventricular rate in AF & SVT of AV node.  Shortens refractory period and enhances conduction and excitability in other parts of the heart.  Side effects: GI disturbances, xanthopsia, arrhythmias
  • 14. Therapeutic Procedures • External defibrillation and cardio version • Catheter ablation • Temporary pacemakers • Permanent pacemakers • Implantable cardiac defibrillators(ICDs) • CRT (cardiac resynchronization therapy
  • 15. External defibrillation
  • 16. cardio version
  • 17. Catheter ablation
  • 18. Flouroscopic image showing catheter
  • 19. pacemakerImplantable cardiac defibrillators(ICDs)
  • 20. pacemaker ICDs
  • 21. CRT (cardiac resynchronization therapy)