Abstract
Acute pharmacologic management of ventricular and supraventricular cardiac arrhythmias has undergone extensive changes in the past 5 years. Since its release for general use in 1991, adenosine has been the agent of choice for acute termination of AV nodal reentrant and AV reciprocating tachycardias. For acute heart rate control in atrial fibrillation, the effects of intravenous diltiazem are more rapid and efficacious than those of digoxin. lbutilide is the first intravenous agent approved by the Food and Drug Administration for rapid termination of atrial fibrillation and flutter and has been shown to be superior to procainamide and sotalol for this indication. For sustained monomorphic ventricular tachycardia not associated with acute myocardial infarction or ischemia, procainamide rather than lidocaine is the agent of choice. For refractory ventricular tachyarrhythmias, intravenous amiodarone has become the new drug of choice, displacing bretylium in this treatment.
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