Cardioversion atrial tachyarrhythmias

An important step in symptom-targeted therapy that acts to decrease pulmonary venous pressures is to maintain atrial contraction and atrioventricular (AV) synchrony. Maintaining atrial contraction and AV synchrony is important both in preserving normal cardiac output and in keeping LV diastolic pressure low. Chemical or electrical cardioversion of persistent atrial tachyarrhythmias will decrease diastolic pressure, increase cardiac output, and resolve pulmonary edema. An AV sequential pacemaker should be used to treat bradyarrhythmias in patients requiring pacing. 

ICDs come in both ventricular and dual chamber varieties. Dual chamber ICDs also afford pacemaker function in the atrium, and may, depending on the brand, have the ability to treat paroxysms of atrial tachyarrhythmias with rapid pacing and cardioversion therapies. 

Newer models of ICDs may also be implanted that have additional treatment options specifically for atrial tachyarrhythmias. Therapies can include atrial overdrive ramp/burst pacing (see below), high frequency (50 Hz) burst pacing and cardioversion. 

Therapeutic uses Quinidine is used in the treatment of a wide variety of arrhythmias, including atrial, AV junctional, and ventricular tachyarrhythmias. Quinidine is used to maintain sinus rhythm after direct current cardioversion of atrial flutter or fibrillation and to prevent frequent ventricular tachycardia. 

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