Treatment of arrhythmias

Antiarrhythmic treatment

Arrhythmias are difficult to treat with drugs. Treatment with antiarrhythmics can cause other arrhythmias and thus worsen the prognosis. All antiarrhythmics have a negative inotropic effect to some extent. Their action can induce re-entries, torsades de pointes, and prolongation of the repolarisation, which can cause new arrhythmias. In AF, the two principal therapeutic goals are symptom control and the prevention of thromboembolism. Symptomatic treatment may be approached in two ways: rhythm control or rate control. Rhythm control aims to achieve a normal sinus rhythm. This is performed by defibrillation and medication with class I and class III antiarrhythmic drugs. Hypertension is a common underlying cause of atrial fibrillation and hence, additional therapy with ACE inhibitors or AT2 antagonists might be required.

Rate control aims to maintain a HR of < 80 bpm and to control symptoms, even when the patient remains in AF. This may be achieved by implanting an implantable defibrillator (ICD) or with pharmacological treatment. Pharmacological treatment involves ß-blockers, digoxin, and/or verapamil. However, the dosing of this treatment is difficult and patients cope with many serious side effects. The most successful treatment of re-entry tachycardia is surgical ablation of the spot causing the re-entry. Ventricular fibrillation requires an acute defibrillation. Usually patients with this problem get an internal defibrillator or ICD. This intervention can be supported by pharmacological treatment with amiodarone (class III antiarrhythmic). Underlying causes of ventricular fibrillation are cardiomyopathy and coronary problems. Treating these causes will also prevent fibrillation. Besides controlling the arrhythmia, it is also necessary to prevent thrombus formation. For this purpose, patients receive treatment with aspirin and/or oral anticoagulants.

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Curative treatment for arrhythmias includes which of the following:

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Either electrical or pharmacological cardioversion of long-standing atrial fibrillation should be accompanied by

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Curative treatment for arrhythmias includes which of the following:

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Either electrical or pharmacological cardioversion of long-standing atrial fibrillation should be accompanied by

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Curative treatment for arrhythmias includes which of the following:

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Either electrical or pharmacological cardioversion of long-standing atrial fibrillation should be accompanied by

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Curative treatment for arrhythmias includes which of the following:

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Either electrical or pharmacological cardioversion of long-standing atrial fibrillation should be accompanied by

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Curative treatment for arrhythmias includes which of the following:

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Either electrical or pharmacological cardioversion of long-standing atrial fibrillation should be accompanied by

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Curative treatment for arrhythmias includes which of the following:

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Either electrical or pharmacological cardioversion of long-standing atrial fibrillation should be accompanied by