Management of arrhythmias

Arrhythmias are a frequent presenting symptom requiring further investigation. Not all arrhythmias are of clinical significance, and many need not be treated. Symptomatic and frequently recurring paroxysmal atrial tachycardia, atrial fibrillation with rapid ventricular response, the changing arrhythmias of the tachycardia-bradycardia syndrome should be investigated, and most should be treated. Frequent symptomatic ventricular premature beats need occasionally be treated when they interfere with a patient's quality of life, and when they are associated with serious underlying cardiac disease. Complex and sustained ventricular arrhythmias should be treated following thorough investigation because of the risk of sudden cardiac death. The range of available therapeutic options, pharmaceutical and non-pharmaceutical, has become quite bewildering. Many new anti-arrhythmic drugs have been, and are being, developed; all still have potential pro-arrhythmic effects. New electrosurgical procedures are available, as well as new implantable anti-arrhythmic pacemakers and automatic defibrillators.