[Emergency pharmacotherapy in rhythmology]

Area of Science:

• Clinical Cardiac Electrophysiology
• Emergency Medicine
• Pharmacology

Background:

• Acute cardiac arrhythmias are common and prognostically significant emergencies.
• Arrhythmias range from bradycardia and supraventricular tachycardia to life-threatening ventricular tachyarrhythmias and electrical storm.
• Rapid, structured, and guideline-based pharmacotherapy is essential to prevent hemodynamic instability and mortality.

Purpose of the Study:

• To review the essential pharmacotherapy for acute cardiac arrhythmias.
• To highlight the importance of established antiarrhythmic drugs in emergency settings.
• To discuss the role of specific agents in complex ventricular arrhythmias.

Main Methods:

• Review of current clinical practices and literature on acute arrhythmia management.
• Analysis of drug selection criteria based on arrhythmia type, hemodynamic status, and patient factors.
• Discussion of established and less common antiarrhythmic agents.

Main Results:

• Selection of emergency medication depends on arrhythmia, hemodynamics, and patient factors.
• Classical antiarrhythmic drugs, AV nodal agents, beta-blockers, calcium channel blockers, adenosine, glycosides, and catecholamines are key.
• Established drugs remain important due to lack of new approvals; procainamide and mexiletine are considered for complex ventricular arrhythmias.

Conclusions:

• Effective management of acute cardiac arrhythmias relies on appropriate pharmacotherapy.
• Established antiarrhythmic drugs are cornerstones of emergency treatment.
• Specialized agents may be crucial for refractory or complex ventricular arrhythmias.