Older man with ICM and heart failure presenting with multiple AICD shocks and found to have VT storm
Dr. Angelo Biviano | Morning Report | 08/25/2016 | video
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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
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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
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- 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
- For stable VT, initiate antiarrhythmic drug therapy
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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
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For further reading...
Posted 08/25/16 10:54:15 AM by Anna Krigel
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