Management

Sinus tachycardia

• Treat the underlying cause of dysrhythmia

Sinus bradycardia

• Treat only if the patient is symptomatic

• Determine the underlying cause

• If appropriate, administer atropine

• Consider isopreterenol (used rarely) or a pacemaker, if appropriate

Atrial flutter

• Convert rhythm to sinus rhythm or controlled ventricular rate to provide adequate cardiac output

• Rate control: Beta blockers and calcium channel blockers

• Anticoagulants to prevent thromboemboli formation

• Vagal maneuvers, adenosine

• Other: Cardioversion, atrial-based pacing, atrial defibrillators, catheter ablation, pharmacologic cardioversion: procainamide, flecainide, dofetilide, ibutilide

Atrial fibrillation

• Convert rhythm to sinus rhythm or controlled ventricular rate to provide adequate cardiac output

• Use cardioversion (generally successful in acute cases of atrial fibrillation)

• Rate control: Beta blockers and calcium channel blockers; digitalis if left ventricular function is reduced; amiodarone

• Anticoagulants to prevent thromboemboli formation

• Other: Atrial-based pacing, atrial defibrillators, catheter ablation

Paroxysmal supraven-tricular tachycardia

• Attempt noninvasive treatment with stimulation of vagal reflex by Valsalva's maneuver or carotid massage (in patients without carotid bruits)

• Treat with adenosine or calcium channel blockers

• Synchronized cardioversion

• Other: calcium channel blockers like verapamil, diltiazem or beta blockers like metoprolol or esmolol.

Pharmacologic Highlights

Medication or

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