Supraventricular and ventricular arrhythmias: medical management

Abstract Cardiac arrhythmia results in significant morbidity and mortality in the western world and presents an ever-increasing economic burden on health services. Optimal heart rhythm management may not only improve patients' quality of life, but timely diagnosis, treatment and specialist referral of patients with arrhythmias may permit the provision of both cost-effective and life-saving treatments. The accurate diagnosis of patients presenting acutely with arrhythmias requires skill in ECG interpretation. However, non-specialists can readily apply the simple principles that underline safe and effective management of such patients. An additional understanding of arrhythmia pathogenesis and basic pharmacology is all that is required to achieve a high degree of competence in all emergency room management scenarios and in the long-term care of patients with arrhythmia. This article aims to provide the reader with a ‘toolkit' for the medical management of cardiac arrhythmias, with a particular focus on the acute setting. The indications for other important therapies, such as catheter ablation and implantable cardioverter defibrillators, are outlined as appropriate, but these subjects are covered fully elsewhere.