antiarrhythmics: specific conditions/treatments

1. Afib//flutter

1.1. control rapid vent response -> rate control

1.1.1. dilitazem, verapamil, digoxin, BB

1.2. restores sinus rhythm

1.2.1. 3 weeks of therapeutic anticoag before attempts

1.2.2. type IC and type III = pure K channel blockers

1.3. prevent complications like thromboembolism and recurrence

1.3.1. warfarin indefinitely for all pts w/ afib flutter and high risk for stroke

2. paroxysmal SVT

2.1. narrow QRS complex

2.1.1. CCB or adenosine

2.2. wide regular QRS

2.2.1. adenosine or procainamide

2.3. wide and irregular QRS

2.3.1. procainamide (can be an accessory pathway)

2.4. try vagal maneuvers to increase vagal tone; recurrent episodes of pSVT may require identification of the reentry circuit and radioablation

3. ventricular premature beats

3.1. BB in pts with heart disease and complex vent beats

4. ventricular tachycardia

4.1. severe sxs

4.1.1. direct current cardioversion

4.2. mild sxs

4.2.1. amiodaron or procainamide

5. vent fibrillation

5.1. 1. shock, shock -> epinephrine or vasopressin

5.2. 2. shock again then give amiodarone

5.3. 3. after successful resuscitation pts need close monitoring for recurrence and may need an implantable cardioverter-defibrillator