Via practica 6/2008

PHARMACOLOGICAL TREATMENT OF SUPRAVENTRICULAR ARRHYTHMIAS

Supraventricular arrhythmias are a group of cardiac rhythm disturbances, that are relatively common and rarely life threatening. The most common treatment strategies include antiarrhythmic drug therapy, external direct current cardioversion and catheter ablation. Symptom severity depends on the presence of structural heart disease and hemodynamic reserve of the patient. The most common forms of AV nodal – dependent tachycardias are AV nodal reentrant tachycardia (AVNRT) and AV reciprocating tachycardia (AVRT). Antiarrhythmic drugs are appropriate for hemodynamic stable forms. Acute therapy for patients with atrial flutter depends on clinical presentation. If the patient presents with acute hemodynamic collapse or CHF, then emergent DC-synchronised shock is indicated, if the patient present is hemodynamically stable we can use AV-nodal-blocking drugs for rate control. For long-term management of atrial flutter preffered catheter ablation and antiarrhythmic drugs are appropriate for recurrent and well-tolerated atrial flutter. The main problem in management of atrial fibrillation is associated with arrythmia and prevention of thromboembolism. Pharmacological cardioversion seems most effective when initiated within 7 days after onset of an episode atrial fibrillation. Antiarrhythmic drugs therapy is appropriate for maintain sinus rhythm after successfully cardioversion and for rate control during permanent and persistent atrial fibrillation.

Keywords: supraventricular arrhythmias, atrial fibrillation, atrial flutter, antiarrhythmic drugs.