[Anticoagulation--control of heart rate--cardioversion. Therpeutic algorithm in ventricular tachycardia]

The first therapeutic step in the emergency situation absolute tachyarrhythmia in underlying atrial fibrillation is the immediate initiation of anticoagulation treatment with heparin, followed by control of the ventricular frequency. Cardioversion promises success when: atrial fibrillation < 48 hours, transesophageal echocardiography excludes a thrombus, > 3 weeks effective anticoagulation, left ventricle < 50 mm, and atrial fibrillation not longer than one year. In the emergency situation electric cardioversion is to be preferred to drug-induced cardioversion. If the pumping function is reduced, amiodarone is a safe agent for rhythm stabilization. Care must be exercised with verapamil, digitalis and adenosine in irregular broad QRS complex tachycardia and suspected WPW syndrome.