Key result
Prompt diagnosis, early defibrillation, and appropriate use of antiarrhythmic drugs such as amiodarone are essential for managing critical supraventricular and ventricular arrhythmias.
Amiodarone and ibutilide are effective for acute management of atrial arrhythmias, and early defibrillation is the most critical intervention for ventricular fibrillation in emergency settings.
Supports emergency arrhythmia protocols; leaves open need for updated comparative trials on drug sequencing.
Atrial fibrillation (AF), atrial flutter, AV-nodal reentry tachycardia with rapid ventricular response, atrial ectopic tachycardia and preexcitation syndromes combined with AF or ventricular tachyarrhythmias (VTA) are typical arrhythmias in intensive care patients (pts). Most frequently, the diagnosis of the underlying arrhythmia is possible from the physical examination (PE), the response to maneuvers or drugs and the 12-lead surface electrocardiogram. In unstable hemodynamics, immediate DC-cardioversion is indicated. Conversion of AF to sinus rhythm (SR) is possible using antiarrhythmic drugs. Amiodarone has a conversion rate in AF of up to 80%. Ibutilide represents a class III antiarrhythmic agent that has been reported to have conversion rates of 50-70%. Acute therapy of atrial flutter (Aflut) in intensive care pts depends on the clinical presentation. Atrial flutter can most often be successfully cardioverted to SR with DC-energies <50 joules. Ibutilide trials showed efficacy rates of 38-76% for conversion of Aflut to SR compared to conversion rates of 5-13% when intravenous flecainide, propafenone or verapamil was administered. In addition, high dose (2 mg) of ibutilide was more effective than sotalol (1.5 mg/kg) in conversion of Aflut to SR (70 versus 19%). Drugs like procainamide, sotalol, amiodarone or magnesium were recommended for treatment of VTA in intensive care pts. However, only amiodarone is today the drug of choice in VTA pts and also highly effective even in pts with defibrillation-resistant out-of-hospital cardiac arrest (CA). There is a general agreement that bystander first aid, defibrillation and advanced life support is essential for neurologic outcome in pts after cardiac arrest due to VTA. Public access defibrillation in the hands of trained laypersons seems to be an ideal approach in the treatment of ventricular fibrillation (VF). The use of automatic external defibrillators (AEDs) by basic life support ambulance providers or first responder (FR) in early defibrillation programs has been associated with a significant increase in survival rates (SRs). However, use of AEDs at home cannot be recommended.
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Hans‐Joachim Trappe (2010) conducted a review in Supraventricular and ventricular arrhythmias. Prompt diagnosis, early defibrillation, and appropriate use of antiarrhythmic drugs such as amiodarone are essential for managing critical supraventricular and ventricular arrhythmias.
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