Atrial arrhythmias flutter

Primary indications for the use of quinidine include (1) abolition of premature complexes that have an atrial, A-V junctional, or ventricular origin (2) restoration of normal sinus rhythm in atrial flutter and atrial fibrillation after controlling the ventricular rate with digitahs (3) maintenance of normal sinus rhythm after electrical conversion of atrial arrhythmias (4) prophylaxis against arrhythmias associated with electrical countershock (5) termination of ventricular tachycardia and (6) suppression of repetitive tachycardia associated with Wolff-Parkinson-White (WPW) syndrome. 

It is indicated in prevention of atrial arrhythmia, atrial fibrillation or flutter, paroxysmal supraventricular tachycardia, ventricular premature beats and ventricular tachycardia. 

Digitalis is useful in the management of atrial arrhythmias because of its cardioselective parasympathomimetic effects. In atrial flutter and fibrillation, the depressant effect of the drug on atrioventricular conduction helps to control an excessively high ventricular rate. Digitalis has also been used in the control of paroxysmal atrial and atrioventricular nodal tachycardia. At present, calcium channel blockers and adenosine... 

Aminocycloalkyl cinnamide derivatives, (III), prepared by Beatch (3) were effective in the treatment and termination of atrial fibrillation/flutter arrhythmia events. 

Altered rate of automatic discharge or abnormality of the mechanism by which an impulse is generated from a centre in the nodes or conducting tissue, is one cause of cardiac arrhythmia, e.g. atrial fibrillation, flutter or tachycardia. 

Adenosine is the treatment of choice for PSVT. It slows the conduction and interrupts the re-entry pathways through the atrioventricular node, restoring dysrhythmia to NSR. Adenosine is not effective in treating other atrial arrhythmias such as atrial flutter or atrial fibrillation or in treating ventricular arrhythmias. Adenosine is rapidly degraded... 

Most side effects of /3-blockers are an extension of their ability to antagonize /3-adrenoceptors. /3-Blockade in the myocardium can be associated with bradycardia, atrioventricular conduction abnormalities (e.g., second- or third-degree heart block), and the development of acute heart failure. The decreases in heart rate actually may benefit certain patients with atrial arrhythmias (e.g., atrial fibrillation and atrial flutter) and hypertension by both providing rate control and lowering BP. /3-Blockers usually only produce heart failure if... 

Pedersen OD, Bagger H, Keller N, et al. Efficacy of dofetilide in the treatment of atrial fibrillation-flutter in patients with reduced left ventricular function. The Danish Investigation of Arrhythmia and Mortahty ON Dofetilide (DIAMOND) substudy. Circulation 2001 104 292-296. 

Quinidine is used in the therapy of atrial arrhythmias, particularly atrial flutter and atrial fibrillation. It is also useful in other types of arrhythmias (e.g., v-tac), and is also useful in the treatment of malaria, when given intravenously. 

Adenosine is most useful in the therapy of supraventricular tachycardias such as Wolff-Parkinson-White syndrome. It is not effective against normal atrial arrhythmias such as atrial flutter and atrial fibrillation. 

Supraventricular arrhythmias arise from atrial or accessory pathways. They are not life threatening unless the arrhythmia is communicated to ventricular pathways. Atrial arrhythmias include atrial flutter and atrial fibrillation. 

Newly developed class III drugs comprise dofetilide, a specific Ik, blocker, and ibutilide, which blocks IKl and activates the slow iNa- Both drugs lack hemodynamic side effects. These drugs are scheduled for the treatment of atrial fibrillation and atrial flutter. As with class HI drugs, they can induce torsade de pointes arrhythmia. 

The risk of atrial flutter is a 2 1 transmission to the ventricles generating a high ventricular rate. The therapeutic goal is to reduce transmission to 3 1 or 4 1 by administration of either (3-adrenoceptor antagonists, Ca2+ channel blockers or amiodarone. Quinidine must not be used in this arrhythmia, since it accelerates AV-conduction due to its vagolytic effect. 

The uses of the antiarrhythmic drug are given in the Summaiy Drug Table Antiarrhythmic Drug3. In general these drugp are used to prevent and treat cardiac arrhythmias, such as premature ventricular contractions (PVCs), ventricular tachycardia (VT), premature atrial contractions (PACs), paroxysmal atrial tachycardia (PAT), atrial fibrillation, and atrial flutter. Some of the antiarrhythmic dru are used for other... 

Heart Fever, lethargy, weakness, SOB, DOE, hypotension, tachycardia, atrial flutter, ventricular arrhythmias Leukocytosis, endomyocardial biopsy positive for mononuclear infiltrates... 

EKGs taken on two workers about 2.5 hours after an acute exposure to hydrogen sulfide showed cardiac arrhythmias (Krekel 1964). The workers were exposed for <5 minutes after a spill of sodium sulfide that broke down to release hydrogen sulfide. In one individual, a negative P wave indicating a substitute rhythm was noted, while in the other individual a continuous arrhythmia due to atrial flutter was found. EKGs for both men had returned to normal within 24 hours. 

Common supraventricular tachycardias requiring drug treatment are atrial fibrillation (AF) or atrial flutter, paroxysmal supraventricular tachycardia (PSVT), and automatic atrial tachycardias. Other common supraventricular arrhythmias that usually do not require drug therapy are not discussed in this chapter (e.g., premature atrial complexes, wandering atrial pacemaker, sinus arrhythmia, sinus tachycardia). 

Atrial flutter is characterized by rapid (270 to 330 atrial beats/min) but regular atrial activation. The ventricular response usually has a regular pattern and a pulse of 300 beats/min. This arrhythmia occurs less frequently than AF but has similar precipitating factors, consequences, and drug therapy. 

The desired outcome depends on the underlying arrhythmia. For example, the ultimate treatment goals of treating AF or atrial flutter are restoring sinus rhythm, preventing thromboembolic complications, and preventing further recurrences. 

Cardiovascular manifestations include hypertension and cardiac arrhythmias (e.g., heart block, atrial flutter, paroxysmal atrial tachycardia, ventricular fibrillation, and digitalis-induced arrhythmias). In severe hypokalemia (serum concentration <2.5 mEq/L), ECG effects include ST-segment depression or flattening, T-wave inversion, and U-wave elevation. 

Verapamil is used for preventing angina pectoris attacks, arterial hypertension, and treating and preventing supraventricular arrhythmia (paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, extrasystole). Synonyms of this drug are isoptin, calan, fmoptin, falicard, manidone, and many others. 

Dofetilide is approved for the treatment of atrial fibrillation and atrial flutter. Because of the lack of significant hemodynamic effects, dofetilide may be useful in patients with CHF who are in need of therapy for supraventricular tachyarrhythmias. Dofetilide is not indicated for use in the setting of ventricular arrhythmias. 

Verapamil is useful for slowing the ventricular response to atrial tachyarrhythmias, such as atrial flutter and fibrillation. Verapamil is also effective in arrhythmias supported by enhanced automaticity, such as ectopic atrial tachycardia and idiopathic left ventricular tachycardia. 

Contraindications Phenylephrine HCl injection should not be used with patients with severe hypertension, ventricular tachycardia or fibrillation, acute myocardial infarction (Ml), atrial flutter or fibrillation, cardiac arrhythmias, cardiac disease, cardiomyopathy, closed-angle glaucoma, coronary artery disease, patients who have a known hypersensitivity to phenylephrine, sulfites, or to any one of its components. 

Documented, life-threatening arrhythmias PO (Befapace, Sorlne) Inlllally, 80 mg fwlce a day. May Increase gradually af 2- fo 3-day Infervals. Range 240-320 mg/day. Atrial fibrillation, atrial flutter PO (Befapace AF) 80 mg fwlce a day. 

Arrhythmias, including prevention of recurrent paroxysmal supraventricular tachycardia and control of ventricular resting rate in chronic atrial fibrillation or flutter (with di-goxin) PO 240-480 mg/day in 3-4 divided doses. 

---