Supraventricular arrhythmias atrial

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). 

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. 

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

Paroxysmal supraventricular tachycardia, atrial fibrillation and flutter. Not of benefit in treatment of ventricular arrhythmias Miscellaneous... 

In the USA, amiodarone is approved for oral and intravenous use to treat serious ventricular arrhythmias. However, the drug is also highly effective for the treatment of supraventricular arrhythmias such as atrial fibrillation. As a result of its broad spectrum of antiarrhythmic action, it is very extensively used for a wide variety of arrhythmias. Amiodarone has unusual pharmacokinetics and important extracardiac adverse effects. Dronedarone, an analog that lacks iodine atoms, is under investigation. 

Diltiazem appears to be similar in efficacy to verapamil in the management of supraventricular arrhythmias, including rate control in atrial fibrillation. An intravenous form of diltiazem is available for the latter indication and causes hypotension or bradyarrhythmias relatively... 

These agents appear to be similar in efficacy to verapamil in the management of supraventricular arrhythmias, including rate control in atrial fibrillation. An intravenous form of diltiazem is available for the latter indication and causes hypotension or bradyarrhythmias relatively infrequently. Bepridil also has action potential- and QT-prolonging actions that theoretically may make it more useful in some ventricular arrhythmias but also create the risk of torsade de pointes. Bepridil is only rarely used, primarily to control refractory angina. 

Adenosine is the treatment of choice for diagnosis and reversal of supraventricular arrhythmias. Verapamil is an alternative for the management of narrow complex tachycardias. Amiodarone is the most effective drug at reversing atrial fibrillation, and in prevention of ventricular arrhythmias, but has several adverse effects. 

Digitalis glycosides are positive inotropic agents used in the management of patients with congestive heart failure. They control ventricular rate in supraventricular arrhythmias including atrial fibrillation and atrial flutter. 

Verapamil, proprietaiy name Calan, is a calcium channel blocker that is effective in the treatment of various cardiovascular disorders, including angina (classical and variant), arrhythmias (paroxysmal supraventricular tachycardia), atrial flutter, atrial fibrillation, hypertrophic cardiomyopathy (idiopathic hypertrophic subaortic stenosis), hypertension, congestive heart failure, and Raynaud s phenomenon, along with the preservation of ischemic myocardium and the treatment of migraine headaches. 

Atrial fibrillation is a relatively frequent supraventricular arrhythmia (10-12% of cases) (Figure 4.16 Sugiura et al, 1985), as other supraventricular arrhythmias are typically related to atrial involvement (Liu, Greenspan and Piccirillo, 1961 Zimerman, 1968) and/or pericarditis. Atrial fibrillation occurs usually in the most extensive ACSs. However, in patients with ACS due to RCA occlusion, it may be explained by vagal overdrive and maybe accompanied by AV block. Age, presence of abnormal P wave (Agarwal, 2003), chronic obstructive pulmonary disease (COPD) and heart failure are triggering factors. The incidence of atrial fibrillation has decreased in the post-thrombolytic era. 

Other supraventricular arrhythmias, such as supraventricular paroxysmal tachycardia or atrial tachycardia secondary to an ectopic focus, are much less frequent. 

From the prognostic point of view, these usually correspond to large anteroseptal or inferolateral infarctions. In case of acute inferior MI the presence of PR-segment depression >1.2 mm in inferior leads has been demonstrated to be a marker of higher risk of in-hospital mortality and cardiac rupture (Jim et al., 2006) (Figure 10.6). Often these cases present supraventricular arrhythmias, especially atrial fibrillation. 

Arrhythmia can evolve rapidly within a few seconds, benign supraventricular arrhythmias can turn into other types of rhythm disorders, such as nodal tachycardia, atrial fibrillation and multiple ventricular extrasystoles, in doublets or triplets. It is important to act quickly - which is easy as everything that is needed to deal with these arrhythmias (fortunately very rare) is ready to hand and the patient is on a drip. 

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. 

Class IC drugs Flecainide is effective in both atrial and ventricular arrhythmias but is approved only for refractory ventricular tachycardias that tend to progress to VF at unpredictable times, resulting in sudden death, and for certain intractable supraventricular arrhythmias. 

Patients with chronic atrial fibrillation—a common supraventricular arrhythmia—routinely receive warfarin to prevent the development of blood clots in the poorly contracting atrium and to decrease the risk of embolism of such clots to the brain or other tissues. Such patients are also often treated with anti arrhythmic drugs. The primary goals of antiarrhythmic treatment are to slow the atrial rate and, most importantly, control the ventricular rate. 

Supraventricular tachycardia 35 5 Program additional detection criteria (sudden onset, morphology) Consider therapy for supraventricular arrhythmias (tachycardia, drugs, or AV node ablation for atrial fibrillation) Consider implantation of an atrial lead. 

Almost any type of supraventricular tachycardia (atrial fibrillation, atrial flatter, atrial tachycardia, sinus tachycardia) may be associated with a ventricular rate that falls within the detection criteria for an ICD. In one stndy, approximately 70% of inappropriate therapies are due to supraventricular arrhythmias being misclassified as ventricular arrhythmias requiring therapy (81). 

Verapamil. Verapamil hydrochloride (see Table 1) is a synthetic papaverine [58-74-2] C2qH2 N04, derivative that was originally studied as a smooth muscle relaxant. It was later found to have properties of a new class of dmgs that inhibited transmembrane calcium movements. It is a (+),(—) racemic mixture. The (+)-isomer has local anesthetic properties and may exert effects on the fast sodium channel and slow phase 0 depolarization of the action potential. The (—)-isomer affects the slow calcium channel. Verapamil is an effective antiarrhythmic agent for supraventricular AV nodal reentrant arrhythmias (V1-2) and for controlling the ventricular response to atrial fibrillation (1,2,71—73). 

Paroxysmal supraventricular tachycardia (PSVT) is a term that refers to a number of arrhythmias that occur above the ventricles and that require atrial or AV nodal tissue for initiation and maintenance.32 The most common of these arrhythmias is... 

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