• Anti-tachycardia pacing = pacing the ventricle fast so that the ventricular tachycardia is suppressed by pre-empting of the depolarization of myocytes around a myocardial scar
  
  

  Posted 08/25/16 10:32:15 AM by Anna Krigel

• Vaughn Williams classification of antiarrhythmic drugs
  • Class IA (moderate Na channel blocking) - procainamide, quinidine, disopyramide
  • Class IB (mild Na channel blocking) - lidocaine, mexilitine, phenytoin
  • Class IC (severe Na channel blocker) - flecainde, propafenone
  • Class II - beta adrenergic receptor blockers
  • Class III (K channel blocking) - amiodarone, dofetilide, ibutilide, sotalol, dronedarone
  • Class IV - non-dihydropyridine calcium channel blockers
  
  

  Posted 08/25/16 10:38:17 AM by Anna Krigel

• Treatment of sustained ventricular tachycardia with a pulse
  • For stable VT, initiate antiarrhythmic drug therapy
    • IV amiodarone
    • IV lidocaine
    • IV procainamide
    • Urgent electrical cardioversion
  • For chronic therapy
    • Beta blockers - offer survival benefit
    • ICD therapy - offer survival benefit
    • Ablation - kills tissue in scar where tachycardia is coming from, though no survival benefit
    • Antiarrhythmic drug therapy - primarily sotalol or amiodarone, though no survival benefit
  
  

  Posted 08/25/16 10:47:27 AM by Anna Krigel

• Long QT predisposes to torsades de pointes -> treatment can be to place temporary pacemaker and pace the patient faster to lower the QT interval
  Lidocaine shortens QT interval
  
  

  Posted 08/25/16 10:48:38 AM by Anna Krigel

• For further reading...

  SCD-HeFT
  Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs
  
  

  Posted 08/25/16 10:54:15 AM by Anna Krigel

Created by Christopher Kelly
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