Emergency management of acute cardiac arrhythmias

Anything other than normal sinus rhythm can be classified as an arrhythmia. However not all arrhythmias need acute intervention.

This article reviews which arrhythmias need intervention in an acute setting, and the various options available for intervention.

The impact of an arrhythmia upon perfusion determines what intervention should be considered. Conscious level, cardiac ischaemia secondary to poor perfusion of the coronary arteries and blood pressure need to be assessed. Patients with bradycardias with adequate perfusion are treated initially with oxygen and observation. Sinus bradycardia not responding to increased oxygenation is treated with atropine. For other bradycardias the two alternatives are to drive the inherent rate with a sympathomimetic drug or to pace the patient with an external or internal pacer. Usually supraventricular tachycardias are not life threatening. Unconscious patients with wide complex tachycardia should be treated in a standard cardiac arrest approach. Conscious patients in ventricular fibrillation however, can be treated either chemically or with synchronised cardioversion. If a patient is in cardiac arrest the approach is to establish effective resuscitation and early defibrillation as per Australian Resuscitation Council guidelines.