Arrhythmia treatment should include treatment and prevention of onset of attack of the treatment of arrhythmia is a relatively complex process In addition to causes of treatment, drug treatment can still be divided into two areas and non-drug treatment
There are the following:
A. Dispel incentive to eliminate all factors that can cause cardiac arrhythmia arrhythmias should avoid smoking and drinking do not drink concentrated tea and coffee; if drug-induced arrhythmia is to disable the drug
2. Treatment of the cause is the cause of radical treatment of cardiac arrhythmia a major cause of treatment methods, including adjustments to correct abnormal heart pathological changes pathophysiological functions (such as coronary artery stenosis pump dynamic tension changes in the autonomic nervous dysfunction, etc.) such as in patients with hyperthyroidism caused by sinus tachycardia Speed thyroid function returned to normal sinus tachycardia also has been corrected; coronary heart disease myocardial ischemia-mediated arrhythmia lifted artery stenosis myocardial blood perfusion in normal atrioventricular reentrant arrhythmias will disappear, or AV nodal reentrant tachycardia caused by reentry blocked the extra channels will be able to terminate the tachycardia
3. For the treatment of arrhythmia
(1) Drug therapy: It is the main treatment for arrhythmia arrhythmia due to the complexity of the ways and means of drug action is not the same as the application of generic drugs with oral-based acute intravenous or aerosol medication is applied topical application of more less complex and diverse due to arrhythmia mechanism is not clear why a number of factors have a certain degree of difficulty of clinical medicine general principles should be based on arrhythmia mechanism for selecting the role of targeted adverse effect of a clear and small, slow arrhythmia drug therapy is generally used Enhanced myocardial self-discipline, and (or) accelerated conduction to be sympathetic drugs, such as drugs (isoproterenol, etc.) vagus nerve inhibitory drugs (atropine) or alkaline agent (molar sodium lactate or sodium bicarbonate) in treatment of tachyarrhythmias were selection of slow conduction and prolong refractory period of the drug, such as the vagus nerve stimulants (neostigmine digitalis) is intended to sympathetic drugs indirectly excited vagus nerve (methoxamine phenylephrine) or anti-arrhythmic drugs
Clinical application of the current anti-arrhythmic drugs often have more than 50 kinds of drugs on the myocardial cells by the role of action potentials to classify (Vaugham Williams Act) (Table 3) Ⅰ inhibition 0 divided class medicine has been known as the membrane inhibitor of polar according to the strength and the inhibition of the refractory period and conduction velocity of the different effects is further divided into Ⅰ a Ⅰ b and Ⅰ c sub-classes respectively, of lidocaine and encainide quinidine drug class Ⅱ as a representative for the adrenergic β-receptor blocking hysteresis agents; Ⅲ class to extend the action potential duration and refractory period in order to amiodarone for the representation of drugs; Ⅳ category is the calcium influx blocker verapamil for the representation of drugs in recent years, with another Sicilian Gambie classification of antiarrhythmic arrhythmogenic drug treatment does not destroy the pathological lesions in just that area so that cardiac cell electrophysiological properties such as conduction velocity and (or) should not change in length of long-term use in varying degrees of undesirable side effects can cause serious ventricular arrhythmias or heart block and fatal clinical application and therefore should be strictly and are familiar with the indications of several commonly used anti-arrhythmic effects of drugs, including half-life of absorption of decomposition of the active metabolite excretion dose and side effects (Table 45)
Table 3 Classification of antiarrhythmic drugs
Electrophysiological effects of sub-categories of class on behalf of agents new agents
Ap refractory period conduction velocity time
Ⅰ (sodium channel blockers)
Ⅰ a ↓ ↑ ↑ Queeny Dingpuluka mostly due to amine Disopyramide Ayi Marin (ajmaline)
Pirmenol (pirmenol)
Aprindine aprindine)
Ⅰ b ↓ or ↑ ↓ ↓ lidocaine
Anglo-American West, law phenytoin (mexiletine)
Tocainide (tocainide)
Ⅰ c ↓ ↑ = encainide (encainide)
Flecainide (flecainide)
Lorcainide (lorcainide)
Propafenone (propafenone)
Ethmozine (ethmozin)
Ⅱ (β-blockers) ↓ = ↑ other β blocker propranolol
Ⅲ (action potential duration extension) ↓ = ↑ ↑ amiodarone sotalol (sotabl)
Ⅳ calcium influx blocker verapamil ↓ ↑ Bepridil (bepridil)
Diltiazem
Table 4 commonly used method of anti-tachyarrhythmia medicinal
Indication of the type name of the drug dosage and usage of the major adverse reaction
Room
On
Ventricular
The amount of maintenance dose treatment
Ⅰ a quinidine
quinidine + + + + oral administration of 0.2 ~ 0.4g, a total of five times for each 2h1 times / d cardioversion
Oral 0.2g3 ~ 4 times / d of oral treatment of premature beats 0.2 ~ 0.3g3 ~ 4 times / d long-acting preparations 0.3g every 8 ~ 12h1 views hypotension suppress myocardial contractility intraventricularblock serious ventricular arrhythmias gastrointestinal
Procainamide
intravenous procainamide + + + + per 5min100mg, a total of 1.0 ~ 1.2g, intravenous infusion of 0.5% per min5 ~ 10mg a total of 1 ~ 2g
Oral administration of 0.5 ~ 1.0g, 5 times / d oral administration of 0.25 ~ 0.5g, every 4 ~ 6h1 times hypotension intraventricular conduction block long-term use of ventricular arrhythmia occurred like lupus or rheumatoid-like performance
N-Acetyl procainamide
N-acetylpro -
cainemide + + + + oral administration of 500 ~ 2500mg per 6h1 oral dose of 500 ~ 1000mg per 6h1 times Ibid not cause lupus-like manifestations such as
Disopyramide
intravenous disopyramide + + + + Start 5 ~ 15min in 100mg, followed by intravenous infusion every h20 ~ 30mg
Oral administration of 100 ~ 200mg, 4 times / d oral administration of 100 ~ 200mg, every 6 ~ 8h1 times inhibit cardiac conduction and myocardial contraction in response to dry mouth, urinary retention in the gastrointestinal tract
Antazoline
antazoline + + + + intravenous injection of a 100 ~ 200mg
Oral administration of 0.1 ~ 0.2g, 4 times / d oral administration of 0.1 ~ 0.2g, 4 times / d nausea and vomiting, drowsiness
Pirmenol
pirmenol + + + + within 1h intravenous injection at the End of 2.5mg/kg
Oral administration of 100 ~ 200mg, intravenous drip 0.25mg/min per d2
Oral administration of 100 ~ 200mg, every 2 times / d throat severe headache, constipation, urinary retention insomnia, dizziness rapid ectopic arrhythmia
Chang-phenanthroline
pyrozoline + + + + a 1.5mg/kg intravenous
Oral administration of 0.2 ~ 0.3g, 3 ~ 4 times / d oral 0.2g, 2 ~ 3 times / d nausea and vomiting, discoloration of skin damage to liver and kidney function Leukopenia
阿义Marin
ajmaline + + + + intravenous injection of 50mg (5 ~ 10min Note End)
Oral administration of 100mg, 3 times / d orally 50mg, 3 times / d of liver dysfunction, lethargy and vomiting intravenous administration of neutropenia may have burning sensation
Ⅰ b Lidocaine
lidocaine / + + intravenous injection of 50 ~ 100mg, every 5 ~ 10min50mg, a total of 250 ~ 300mg
Intramuscular injection of 250 ~ 300mg intravenous infusion every min1 ~ 3mg sinus pause atrioventricular block inhibition of myocardial contraction in the limbs twitch drowsiness speech impaired swallowing
Phenytoin
phenytoin + + + intravenous injection of 100mg (5min Note End), and then every 5 ~ 10min100mg, a total of 300 ~ 1000mg orally or by intravenous 0.1g, 3 ~ 4 times / d dizziness, drowsiness neutropenia with intravenous administration of local stimulation with low blood pressure, respiratory depression, sinus pause ventricular arrhythmia
Mexiletine
mexiletine / + + intravenous injection of 100 ~ 200mg or intravenous infusion of 250 ~ 500mg
Oral administration of 200 ~ 300mg, 3 ~ 4 times / d intravenous infusion every min1 ~ 2mg
Oral administration of 200 ~ 300mg, 3 ~ 4 times / d bradycardia hypotension dizziness, nausea and vomiting,
Tocainide
tocainide / + + infusion every min30 ~ 45mg, a total of 15min
Oral administration of 400 ~ 600mg, 3 times / d oral administration of 400 ~ 600mg, 3 times / d dizziness diplopia gastrointestinal reactions
Carbamazepine
carbamazepine + + + oral administration of 100 ~ 200mg, 3 ~ 4 times / d oral administration of 100 ~ 200mg, 3 times / d dizziness drowsiness indigestion
Aprindine
aprindine + + + intravenous infusion of 200mg (per min2mg), 30min after the 100mg, 6h after the 100mg
Oral administration of 50 ~ 75mg, each 6h1 oral dose of 25 ~ 50mg, 2 ~ 3 times / d dizziness, tremor ataxia hand or refer to gastrointestinal neutropenia inhibition of myocardial contraction
Ⅰ c encainide
encainide + + + + intravenous injection of 1 ~ 2mg/kg, 15min end note for more than
Oral administration of 25mg, 3 ~ 4 times / d can be gradually increased to 50mg, 3 ~ 4 times / d orally 25mg, 3 ~ 4 times / d dizziness, rash, gastrointestinal reactions and other serious arrhythmias
Flecainide
flecainide + + + + intravenous injection of 1 ~ 2mg/kg, 10min end note for more than
Oral administration of 50 ~ 100mg, 2 times / d can be gradually increased to 200mg, 2 times / d oral administration of 50 ~ 100mg, 2 times / d dizziness, headache, nausea and weakness nervous feeling unusually severe arrhythmia
Lorcainide
lorcainide + + + + intravenous drip every min2mg or 100mg1h End
Oral administration of 100mg, 2 times / d can be gradually increased to 200mg, 2 times / d oral administration of 100mg, 2 times / d insomnia and anxiety, dizziness, headache, nausea and vomiting dream feeling unusually severe arrhythmia
Propafenone
propafenone + + + + intravenous injection of 70mg / sub 3 ~ 5min in Note END
Oral administration of 150mg, 3 ~ 4 times / d oral administration of 300 ~ 600mg / d nausea and vomiting, headache, dizziness, orthostatic hypotension atrioventricular conduction block and interior
Ethmozine
ethmozin + + + + intravenous injection of 1.8mg/kg, 10min or less Note End
Oral administration of 150 ~ 300mg3 times / d oral 100mg3 times / d nausea and vomiting, headache, dizziness ataxia hypotension
West oxacillin morpholine
cibenzoline + + intravenous injection of 1 ~ 2mg/kg
Oral administration of 30 ~ 80mg, 3 ~ 4 times / d, or 120 ~ 160mg, 2 times / d oral administration of 30 ~ 80mg, 3 times / d nausea and vomiting, diarrhea, dry mouth, dizziness, drowsiness weakness of liver function damage of cardiac function arrhythmia suppression
Ⅱ Propranolol
propranolol + + + intravenous injection of 0.5 ~ 1mg (5 ~ 10min Note End)
Oral administration of 20mg, 3 ~ 4 times / d oral administration of 10 ~ 20mg, 3 times / d bradycardia hypotension such as asthma, congestive heart failure
Pindolol
pindolol + + + intravenous injection of 0.2 ~ 1mg
Of oral 5 ~ 10mg, 3 times / d of oral 5 ~ 10mg, 3 times / d
Atenolol
atenolol + + + Oral 25 ~ 50mg1 ~ 2 times / d oral 25 ~ 50mg1 times / d
Metoprolol
metoprolol + + + Oral 25 ~ 50mg2 ~ 3 times / d oral 25mg, 2 times / d
Betaxolol
betaxolol + + + oral administration of 10 ~ 20mg, 1 time / d oral administration of 10 ~ 20mg, 1 time / d
Acebutolol
acebutolol + + + intravenous injection of 10 ~ 20mg
Oral administration of 100mg, 3 times / d oral administration of 100mg, 3 times / d
Esmolol
exmolor + + + infusion every min25 ~ 300μg/kg /
Fluorine Division Laur
flestolol + + + infusion every min0.5 ~ 10μg/kg /
Ⅲ benzyl ammonium bromide
bretylium / + intravenous injection 250mg, every 6 ~ 8h1 times
Oral administration of 0.1 ~ 0.4g, 3 ~ 4 times / d oral 0.1g, 3 ~ 4 times / d blood pressure, nausea and vomiting, orthostatic hypotension fluctuations
Amiodarone
amiodarone + + + + intravenous injection of 250 ~ 500mg
Oral administration of 200mg, 3 ~ 4 times / d oral administration of 200mg, 1 ~ 2 times / d bradycardia skin discoloration corneal micro-deposits of thyroid dysfunction, pulmonary fibrosis, a serious arrhythmia
Sotalol
sotalol + + + + intravenous injection of 20 ~ 60mg / times for more than 10min End Note
Oral start 80 ~ 160mg, 2 times / d orally starting 80mg, 2 times / d similar to propranolol occasional nervous system adverse reactions and serious ventricular arrhythmias
Times Thani set
bethanidine / + oral starting 5 ~ 10mg, 2 times / d after the increase to 10 ~ 30mg, 3 times / d of oral maintenance dose maximum 200mg / d with benzyl ammonium bromide adverse reactions mainly orthostatic hypotension with the
Ⅳ verapamil
verapamil + + + intravenous injection of 5 ~ 10mg (5 ~ 10min Note End)
Oral administration of 80mg, 3 ~ 4 times / d orally 80mg, 3 ~ 4 times / d atrioventricular heart block bradycardia hypotension
Bepridil
bepridil + + + intravenous injection of 3 ~ 4mg/kg1 times
Oral administration of 300 ~ 800mg, 1 time / d oral administration of 300 ~ 800mg, 1 time / d similar to the adverse effects of verapamil can cause ventricular arrhythmias
Diltiazem
diltiazem + + / intravenously every 75 ~ 150μg/kg
Oral administration of 60 ~ 90mg, 3 times / d orally 60mg, 3 times / d similar to the adverse effects of verapamil can cause skin rash
Heart may be set
segontin / + oral administration of 15 ~ 60mg, 3 times / d oral administration of 15 ~ 30mg, 3 times / d bradycardia hypotension
Ⅴ lanatoside C + + + intravenous injection of 0.6 ~ 0.8mg, 2h after the injection 0.2 ~ 0.4mg intravenous 0.4mg, 1 time / d of ventricular arrhythmias or atrial tachycardia atrioventricular junction atrioventricular block gastrointestinal
Digoxin + + + intravenous 0.25 ~ 0.5mg, 4 ~ 6h after the injection 0.25mg
Oral administration of 0.25 ~ 0.75mg, 3 times / d of 2d oral 0.2 ~ 0.5mg, 1 time / d
Digitalis glycosides + + + oral administration of 0.2 ~ 0.3mg, then every 6h0.1mg, 1d within 0.5 ~ 0.7mg oral 0.05 ~ 0.1mg, 1 time / d
Xin-Fu glycosides + + + Oral 0.1 ~ 0.2g (refined products 0.5 ~ 1mg), 1 time / d oral administration of 0.1 ~ 0.2g (refined products 0.5 ~ 1mg), 1 time / d
Its
He neostigmine + / intramuscular injection of 0.5 ~ 1.0mg
Intravenous injection of 5 ~ 10mg / abdominal pain, nausea, muscle twitching bradycardia
Edrophonium edrophonium chloramine + / intravenous injection of 5 ~ 10mg /
Phenylephrine + + / intramuscular injection of 0.5 ~ 1.0mg with systolic blood pressure to 21.3kPa (160mmHg) /
Methoxy-Ming + + / intravenous injection of 5 ~ 10mg, so that systolic blood pressure to 21.3kPa (160mmHg) to stop injection / intraventricular conduction block of atrial standstill gastrointestinal reaction
Intravenous infusion of potassium chloride + + 0.3 ~ 0.5%, a total of 1 ~ 2g per h1g oral 1 ~ 2g3 ~ 4 times / d oral 1g3 ~ 4 times / d intraventricularblock atrial standstill gastrointestinal
Intravenous magnesium sulfate + + 1 ~ 3g (diluted to 10% 20ml injection twice) 10min followed by intravenous infusion of magnesium deficiency than those who inject finished the first day of 6 ~ 9g, on the second day 2 ~ 3g / blood pressure, respiration decreased heart cardiac standstill moving too slow atrioventricular conduction block and indoor weak sleepiness coma paralyzed
Adenosine triphosphate + / 5 ~ 10mg, or 15 ~ 20mg diluted in 20ml normal saline injected 5s completed within 3 ~ 5min with no response after repeated / atrioventricular block cardiac arrest and ventricular tachycardia
Intravenous injection of 60mg intramuscular matrine + + 20 ~ 40mg oral 1.5 ~ 3.0g, 3 times d oral administration of 1.5 ~ 3.0g, 3 times d nausea, upper abdominal pain, acid reflux
Table 5 commonly used anti-arrhythmic medicinal method is slow
Name of the drug dosage indications and usage of the major adverse reaction
The amount of maintenance dose treatment
Isoprenaline height or complete atrioventricular block with sick sinus cardiac arrest intravenous infusion of 1 ~ 3μg/min (1 ~ 2mg placed in 500ml of 5% glucose solution per minute drip 1ml)
Sublingual every 3 ~ 4h10 ~ 15mg tremor with left headache, skin flushing nausea, dizziness angina pectoris aggravated tachyarrhythmias
Yellow base bed height or complete atrioventricular block muscle or subcutaneously 1 15 ~ 30mg
Oral 25mg3 times / d orally 25mg, 3 times / d nervous insomnia, dizziness high blood pressure tachyarrhythmia
Adrenaline high degree or complete atrioventricular block cardiac arrest 0.1% 0.3 ~ 0.6ml venous or heart chamber muscular injection of subcutaneous intravenous infusion of 1 ~ 4μg/min intravenous infusion of 1 ~ 4μg/min nervous pale tremor hypertension tachyarrhythmias
Atropine-like illness sinus atrioventricular block atropine 1mg subcutaneous or intravenous injection of muscle oral 0.3 ~ 0.6mg3 times / d
Anisodamine intravenous 10 ~ 20mg / oral dose of 5 ~ 10mg, 3 times / d
Pluto benzene Xin oral 15 ~ 30mg, 3 times / d oral administration of 0.3 ~ 0.6mg, 3 times / d
Oral administration of 5 ~ 10mg, 3 times / d
Oral administration of 15 ~ 30mg, 3 times / d dry mouth, glaucoma, urinary retention increased dizziness flushing tachyarrhythmias
Thyroid hormone sinus bradycardia or nodal rhythm, especially those caused by hypothyroidism, thyroxine tablet 0.1 ~ 0.2mg / d
3 triiodothyronine sodium tablets 10 ~ 20ng / d with the performance of the left hyperthyroidism tachyarrhythmias
Adrenal cortex hormones, especially atrioventricular block inflammation caused by intravenous hydrocortisone 200 ~ 600mg (24h period)
Oral prednisolone 10mg4 times / d oral prednisone 10mg, 4 times / d the performance of the adrenal cortex hyperactivity sodium retention diabetes, glaucoma, mental deterioration of inflammation spread
Molar sodium lactate acidosis, or hyperkalemia caused by atrioventricular block cardiac arrest rapid intravenous infusion of trickle-down 25 ~ 50ml, continue to the 5 ~ 7ml/kg finished in a few drops of h, heart failure induced by rapid hypokalemia alkalosis Arrhythmia
Nicotinamide disease Doujing drops 400 ~ 800mg / d (the individual may be increased to 2000mg), 2 ~ 4 Zhou oral administration of 2500mg / d nausea and vomiting, abdominal burning sensation on the skin flushing itching
(2) Electrical treatment: the electrical treatment of arrhythmia has developed rapidly in recent years, both in emergency situations are also electrical cardioversion catheter ablation cure arrhythmia are:
① electrical cardioversion (synchronized or non-synchronous): including the most commonly used in vitro surgical application of electrical cardioversion by transthoracic epicardial electrical cardioversion electrical cardioversion transesophageal electrophysiological examination of the intracardiac electrical cardioversion and the ICD and other DC cardioversion and defibrillation were used to terminate ectopic tachyarrhythmia attacks and ventricular fibrillation through the chest wall with high-pressure direct current short-term effect or a direct effect on the heart so that normal and abnormal pacemaker depolarization at the same time the maximum pacing to restore sinus point of order to ensure the safe use of the R wave on the electrocardiogram in patients with trigger-discharge to avoid the period of depolarization occurs easily lead to ventricular fibrillation may be referred to as synchronized direct current cardioversion for atrial fibrillation ventricular fibrillation and supraventricular tachycardia in turn re-treatment of ventricular flutter and ventricular fibrillation is a non-synchronous DC defibrillation and electrical cardioversion defibrillation efficacy of the rapid, reliable and rapid termination of the above-mentioned security is the main treatment for tachyarrhythmias, but no role in preventing attacks
② electrical stimulation: a transesophageal or intracardiac arrhythmia termination of rapid pacing method
③ pacing therapy: the slow cardiac pacemaker for the treatment of arrhythmia with multiple low-energy current regularly scheduled frequency to stimulate the maintenance of atrial or ventricular heart activity; also for the treatment of reentrant tachyarrhythmias and ventricular fibrillation by a single program control or continuous rapid electrical stimulation of the formation of the suspension returned to
④ catheter ablation: The method of treatment developed rapidly expanding the scope and indications of the treatment effect is getting better and better
(3) Mechanical treatment: for example to stimulate the vagus nerve to stimulate the throat and other eye
(4) surgical treatment: including bypass or slow-channel long QT cut off when the sympathetic ganglia of the surgical treatment of ventricular tachycardia, etc.
Vagal reflex excitement methods are eyeball massage carotid sinus pressure pinch the nose and the exclusion of forced expiratory gas and other living
More recent serious and persistent ectopic tachyarrhythmia, such as recurrent sustained ventricular tachycardia with marked circulatory disturbance recovery of surviving sudden cardiac death or ventricular pre-excitation syndrome combined with extremely fast rate of rapid supraventricular arrhythmia disorders in patients with clinical electrophysiology advocated by the test procedure evoked arrhythmia after intravenous or oral anti-arrhythmic drugs inhibit drug-induced arrhythmia according to the role of judge its efficacy and the treatment plan