Arrhythmia : What you need to
know for ACLS?
• Rhythm recognition is a key skill that one
needs to demonstrate during cardiac arrest
• This can be life saving.
• Early defibrillation
• Decision making on the right therapy
• Uncoordinated contractions within the
ventricles of heart.
• Due to multiple cardiac cells that function as
pacemakers and discharge electrical impulses
in a chaotic manner.
• Reduced / No cardiac output : No pulse
• Will result in Asystole if not treated.
• Commonest cause : Hypoxia /Ischemia
• Types : Fine and Coarse
I/V Amiodarone after 3 shocks
• Broad Complex Tachycardia (QRS > 0.12s)
• Heart rate > 180 beats /mt
• Poly-morphic / Torsade Pointe
• Pulse less vs with pulse
Pulse Less Electrical Activity (PEA)
• Organized electrical activity but without a
• Usually has underlying treatable cause
• Hypovolumea and Hypoxia are the
• If no underlying cause is identified, it will be
treated same as Asystole.
5 Hs and 5 Ts
Hydrogen Ion (Acidosis)
Follow flat line protocol – check leads and gain
Not a true rhythm
State of no electrical activity
Very poor prognosis : ROSC extremely unlikely
Possible underlying cause : 5Hs and 5Ts
Treatment : CPR and Epinephrine
Mobitz Type 1
• Progressive prolongation of PR interval.
• Atrial impulse (P waves) may not be conducted
through AVN and gets blocked and hence no
• No clinical significance unless symptomatic.
Mobitz Type 2
• Non prolongation and fixed PR interval.
• Non conducted p waves
• No ventricular activity -Drop beats / No QRS
Most times Infranodal
P waves with a regular pp interval
QRS complexes with a regular RR interval
QRS complex may be narrow or wide (escape
No relationship between P waves and QRS
• Trans cutaneous or Trans Venous pacemaker
• Atropine (0.5 mg) may be tried
Epinephrine 0.5 -1 mg /kg bw
• No p waves preceding QRS complexes as no
coordinated atrial contractility
• Irregular (variable) RR intervals
• Unstable : Synchronized DC Cardio version
• Stable : Rhythm Control vs Rate Control
• Rhythm : Amiodarone, Sotalol, Flecainide
• Rate control : Beta blocker, Calcium channel
• Anticoagulant if indicated.
• Atrial rate 250 – 350 /mt
• Saw Tooth Appearance
• Ventricular rate depends on Degree of AV
• Electrical foci usually in RA
• Rate Control
• Rhythm Control
• Anti coagulant
• DCC if unstable
Supra Ventricular Tachycardia
• Broad term for various supra ventricular
• Electrical impulses above the ventricular
electrical conducting system.
• Inverted p waves preceding or following qrs
• Review old ECG – exclude WPW
•Drugs – Chemical Cardio version or Rate
• Anti coagulant.
•If unstable : sync. DCC