Electrotherapy in acute cardiac conditions

Abstract

Cardiac arrhythmia is one of the main reasons of admission to emergency units. Arrhythmia can be alone symptom, effect of compromise of stable disease or be caused by acute cardiac event. Temporary pacing according to current guidelines should be limited to advanced atrio-venricular block, life-threatening bradycardia related to cardiac procedures (ie. PCI). This method should not be used routinely but only when chronotro­pic drugs are ineffective. Likelihood of restoration of proper atrio-ventricular conduction, when block persists over 2 days is exiguous so decision of permanent system implantation should be taken earlier. Temporary pacing with stiff lead is related to increased risk of perforation and correlates with an increased risk of permanent device infection. Overdrive pacing should be considered in case of refractory to treatment recurrent ventricular arrhythmias. Immediate implantation of cardioverter-defibrillator should be performed in secondary prevention, when arrhythmia seems not to be related to potentially reversible cause. Frequently recurrent or persistent arrhythmias should be treated pharmacologically or with ablation before system implantation. In randomized trials it was not proved that implantation of ICD based on early risk stratification after myocardial infarction give any benefits. Experts point out the group of patients who could benefit from early (within 40 days after MI) implantation of an ICD. Cardiac resynchronization system implantation may be considered as a thera­py option to decrease congestion. Such treatment may allow the withdrawal of inotropic agents. Treatment of acute cardiac conditions with electrotherapy methods could be an effective therapy worth in selected group of patients.