Arrhythmias - A general overview

Complications

Assessment

Management

Cardioversion options

Advantages

Disadvantages

Indications*

Pharmacological 

Avoids anaesthetic complications
May worsen haemodynamic status Stable/asymptomatic 

Electrical 

Rapid Anaesthetic risk
Skin burns
Haemodynamically unstable or symptomatic 

* the patient with an chronically abnormal rhythm e.g. atrial fibrillation will not respond to cardioversion

Summary of options for management (if full cardiac arrest - go to arrest algorithm instead)

Tachy-arrhythmias

Pharmacological

Electrical
(Monophasic)

Electrical
(Biphasic)

SVT

Verapamil 0.1-0.2mg/kg (max 15mg)/10min*
Adenosine 0.05-0.1 mg/kg rapid push @ 30 sec
50 J (initial) 25 J (initial)

AF 

see chart
100 J (initial) 50 J (initial)

VT

Amiodarone 5mg/kg (max 300mg)/30 min
Lignocaine 1-2mg/kg (max 140mg)/10 min
50 J (initial) 25 J (initial)

AF + WPW

Procainamide 10mg/kg/30min 
50 J (initial) 25 J (initial)

Torsades de pointes

Magnesium 0.2mmol/kg/10min
Isoprenaline 0.1mcg/kg/min (max 10mcg/min)
50 J (initial) 25 J (initial)

Increase energy output each refractory shock by 50-100% e.g. 50, 100, 150 J

* do not use verapamil in age < 12 months 

Brady-arrhythmias