Treatment of tachyarrhythmias Ventricular tachycardia

Lidocaine, amiodarone or magnesium form the mainstay of drug treatment. Overdrive pacing may be used if a pacing wire is in situ, capturing the ventricle at a pacing rate higher than the arrhythmia and gradually reducing the pacing rate. Torsades de pointes may be exacerbated by antiarrhythmics so magnesium or overdrive pacing are safest.

Supraventricular tachycardia and atrial flutter

Carotid sinus massage may be used in patients with no risk of calcified atheromatous carotid deposits. Amiodarone, adenosine or magnesium are usually the most useful drugs in the critically ill. Verapamil may be used if complexes are narrow (no risk of misdiagnosed ventricular tachycardia) although it and other AV node blockers should be avoided in re-entry tachycardias.

Atrial fibrillation

Acute or paroxysmal atrial fibrillation should be treated as for supraventricular tachycardia. Digoxin is more useful for chronic atrial fibrillation and does not prevent paroxysmal episodes.

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