Treatment Of Life-threatening Arrhythmias Research Articles

Emergency Department Management of Life-Threatening Arrhythmias

Emergency treatment of life-threatening arrhythmias is related to appreciation of their hemodynamic consequences. In all case, attention should be paid to treating the patient and not merely the electrical rhythm. Emergency cardioversion or defibrillation should be performed in tachyarrhythmias with associated significant end-organ hypoperfusion. Early drug therapy, stabilization, and referral for definitive therapy may be appropriate when tachyarrhythmias do not produce significant hemodynamic consequences. Asymptomatic bradycardia should not be treated emergently but referred for definitive care in those circumstances in which it is necessary. Bradycardia associated with end-organ hypoperfusion should be treated with trials of atropine, or isoproterenol, or emergency pacemaker insertion, and the stabilized patient referred to the cardiac procedure laboratory or cardiac care unit as appropriate. This same approach to bradyarrhythmias applies regardless of the anatomic and electrophysiologic etiology of the decreased heart rate. Attention to these few management principles clearly stresses the primary importance of the hemodynamic effects of any arrhythmia other than the arrhythmia itself.

Surgical treatment of life-threatening ventricular arrhythmias: The role of intraoperative mapping and consideration of the presently available surgical techniques

T IS well known that ventricular arrhythmias may be serious and even life-threatening. Furthermore, it is also known that these arrhythmias may not be adequately controlled with available medical therapy. It is a logical consequence that if the region of the myocardium responsible for generating such arrhythmias could be identified and was amenable to effective surgical treatment, such treatment would be not only desirable, but also would be a significant advance in antiarrhythmic therapy. The first surgical approach to treatment of ventricular arrhythmia was that reported by Couch,’ who performed a surgical resection of a left ventricular aneurysm as treatment of a lifethreatening arrhythmia in one patient. With the subsequent advances in the various techniques of cardiac catheterization, cardiac electrophysiology, and open heart surgery, it is a natural outgrowth that surgical approaches to treatment of these serious and life-threatening arrhythmias should be considered. The first systematic approach to intraoperative electrophysiologic investigation of ventricular arrhythmias with subsequent therapeutic surgical intervention was reported in 1974 by Fontaine et al.’ They studied three patients with right ventricular tachycardia utilizing epicardial mapping at the time of surgery, followed by selective right ventriculotomy as the surgical therapy. Since that time, active investigation in this field has continued to the point where it is probably reasonable to suggest that we may be at the threshold of yet another era in cardiac surgery, namely, the surgical treatment of lifethreatening ventricular arrhythmias. This article reviews the utility and application of intraoperative electrophysiologic mapping in patients with serious or life-threatening ventricular arrhythmias. In addition, it reviews the present state of surgical treatment of these ventricular arrhythmias.

Haemodynamic Monitoring in the Management Of Cardiogenic Shock in Coronary Care Units

The management and nursing care of patients suffering from acute myocardial infarction has changed dramatically over the past decade. With the establishment of coronary care units offering facilities for cardiac monitoring and staffed with nurses holding a post-basic diploma in intensive nursing, the prevention or effective treatment of life-threatening arrhythmias became feasible and many have survived as a result of this intensive and skilled care.

The coronary-care unit: necessity or luxury?

Since the introduction of the coronary-care unit by Dr. Hughes Day a decade ago, there has been an enormous proliferation of such units throughout the United States. The widespread acceptance of the unit as the standard of treatment for patients with suspected or proved acute myocardial infarction has been based primarily on data, usually collected retrospectively, showing that such a facility leads to marked reduction of in-hospital mortality in such patients through early detection and treatment of life-threatening arrhythmias or sudden cardiac arrest. In view of these findings, possible factors contributing to establishment of coronary-care units may be fear on . . .