Antiarrhythmic drugs remain important for treating cardiac arrhythmias, but research over the last decade has shown previously unrecognised risks for many of these agents. Recent findings and technological advances have led to a shift in management towards radiofrequency ablation and implantable devices.
- If palpitations or syncope are the major feature of the presentation, documentation of the arrhythmia is critical. Every effort should be made to document the heart rhythm during symptoms.
- It is important to be alert to the possibility of ventricular tachycardia. Supraventricular tachycardias with aberrant conduction in the ventricles may present as broad complex tachycardias, but all broad complex tachycardias should be treated as ventricular tachycardia until proven otherwise.
- Electrical cardioversion should be used as soon as practicable for patients with ventricular fibrillation, haemodynamically unstable patients with ventricular tachycardia, and unconscious patients with undetermined rhythms. Cardiopulmonary resuscitation should be performed as required.
- Most of the complications of antiarrhythmic therapy are dose related. Patients should be maintained on the lowest effective dose of any drug.
- A subgroup of patients with asymptomatic atrial fibrillation may be treated safely by rate control rather than repeated attempts to restore sinus rhythm.