Treatment

General principles:

Reassure the patient if there is normal rhythm detected during an episode of palpitations.

If an arrhythmia is demonstrated then treatment is dependent on the type of arrhythmia.

• Supraventricular tachycardia (SVT): The patient should be taught autonomic procedures such as the Valsalva manoeuvre. Drugs that are effective in SVT include:- digoxin, amiodorone, flecainide, beta blockers, verapamil, and quinidine.
• Ventricular tachycardia (VT): effective therapy for VTs includes amiodarone and the class I and II drugs.

An arrhythmia can be terminated using a DC cardio- conversion. Removal of the source of an arrythmia can be achieved in the catheter lab. by transvenous ablation, or surgically e.g. left ventricular aneurysm. There may be a requirement for permanent pacing e.g. for tachyarrhythmias or bradyarrhythmias. Pacing may be used prophylactically in conduction disturbances. More severe types of heart block and conduction disturbances may require permenant pacing and drug therapy respectively.

Notes:

• amiodarone: used in the treatment of Wolff-Parkinson- White (WPW) syndrome. Also used for the treatment of other arrhythmias when other drugs are contra-indicated or ineffective
• verapamil: contra-indicated during an SVT in patients with WPW syndrome. Should not be used in patients who are using, or recently treated with, beta-blockers