Biomedical Engineering Reference
In-Depth Information
Table 4.2
Classi fi cation according to interaction site
Node blockers
Table 4.3
Overview of arrhyth
mia treatments
Stabilizers
Arrhythmia
Antiarrhythmic treatment
Adenosine
Trimecaine
Bradycardia
Atropine, isoprenaline
Calcium channel antagonists
Propafenone
Atrial fi brillation/ fl utter
Propafenone, amiodarone, dronedarone,
sotalol, digoxin,
b
-blockers, calcium
Sotalol
b
-Blockers
channel blockers
Digoxin
Amiodarone
Paroxysmal supraventricular
tachycardia
Adenosine, calcium channel blockers,
b
-blockers, propafenone
Pre-excitation
Procainamide, ajmaline
According to guidelines [ 34 ] , in a simpli fi ed fashion, pace-
maker implantation is indicated for an asystole longer than
3 s, detection of a heart rate below 40 beats/min, and second-
or third-degree AV block. When bradycardias are not clearly
indicated for permanent pacing, no drugs are usually
administered.
Pharmacological treatment of tachycardia involves admin-
istration of antiarrhythmic drugs [ 29, 30 ] . The original drugs
were antiarrhythmic drugs of the Ia group. This group has
numerous side effects and is not very efficacious, and some
of the agents are no longer commercially available.
Antiarrhythmic drugs of the Ic and III groups are better toler-
ated and more efficacious; however, they reduce myocardial
contractility and affect the conductivity of the conduction
system. In supraventricular tachycardia, such as AVRT,
AVNRT, sinus tachycardia, atrial tachycardia, and atrial
Ventricular tachycardia
Lidocaine, amiodarone,
b
-blockers
Ventricular fi brillation
Adrenalin, amiodarone
flutter, AV nodal blockers or propafenone are administered.
In atrial fibrillation, AV nodal blockers (digoxin, verapamil,
b
-blockers) are used to control ventricular rate, and stabiliz-
ers (propafenone, sotalol, amiodarone, or, more recently
dronedarone, a noniodinated amiodarone derivative) are used
to control rhythm. Monomorphic VT with a wide QRS com-
plex is treated with stabilizers (sotalol, amiodarone) over the
long term. Amiodarone is the most commonly used agent in
the long-term treatment of polymorphic VT. Table
4.3
pres-
ents an overview of pharmacological antiarrhythmic therapy.
However, it is an adjunct treatment to ICD implantation to
reduce the rate of shock.
