Pathophysiology and management of atrial and ventricular arrhythmias in the critically ill

The general principles that apply to treatment of arrhythmias in the critically ill include, first, an immediate correction of arrhythmias that result in hemodynamic deterioration. This more frequently necessitates DC cardioversion, pacing, or intravenous therapy than is seen in an otherwise healthy patient. Second, having resuscitated the patient and treated the arrhythmia, the physician should be acutely aware of any precipitating factors, which should then be corrected in order to prevent recurrence of the arrhythmia. Third, the physician should also be aware of the potential proarrhythmic effects of his or her antiarrhythmic drug therapy and be prepared to withdraw therapy when it appears that the arrhythmia has worsened following drug treatment. In the future, new technologic developments, including improved defibrillation systems, intracardiac catheters for defibrillation, and automatic arrhythmia detectors using intravascular catheters, may aid in the diagnosis and treatment of recurrent arrhythmias in the critically ill.