Abstract

Summary Cardiac arrhythmias during anaesthesia are common and almost benign, with the incidence ranging from 60 to 90%. Arrhythmias are one of several significant predictors for severe cardiovascular outcomes. It is essential, therefore, for the anaesthetist to evaluate patients at risk preoperatively with a careful history and to have an appropriate knowledge concerning the aetiology, electrophysiology, diagnosis, drug effects and treatment of arrhythmias. In the normal heart, the sinoatrial node initiates rhythmic cardiac electrical activity by cells with intrinsic pacemaker activity. Sequential atrial and ventricular contractions result in an increased efficiency of the cardiac pumping mechanism, which, in turn, may be affected by arrhythmias. Cardiac arrhythmias are caused by altered automaticity or abnormal impulse propagation, which arise from a variety of factors such as electrolyte disorders, hypoxaemia, hypotension, drugs and other disorders. Patients with underlying heart disease are especially at risk. When there is evidence that a potentially dangerous arrhythmia exists, the patient who presents for elective surgery should be given additional examinations and treated before operation. Although implantable cardioverter defibrillators are now available, there have been reported failures of these devices. In emergency situations, the anaesthetist must know how to treat suspected arrhythmias. Arrhythmias should be treated if they have haemodynamic consequences or if they are potentially dangerous. However, there is growing concern about the safety of antiarrhythmic drugs because these drugs have the potential to fail, increase the severity of arrhythmias or produce other circulatory imbalances. Thus it is important to first eliminate all possible anaesthetic and surgical effects on arrhythmias. Once it is decided to treat an arrhythmic disorder, the available therapeutic approaches are either electrical or pharmacological. Patients with potentially dangerous arrhythmias during anaesthesia must be monitored postoperatively and adequate prophylactic treatment should be initiated under prolonged ECG control.

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