How to Treat All Cardiac Dysrhythmias

1

Are all cardiac dysrhythmias clinically important?

Most are not. Many of us have isolated premature ventricular contractions (PVCs) or premature ventricular depolarizations (PVDs) all the time. Superbly conditioned athletes frequently exhibit resting heart rates in the 30s. A clinically important cardiac dysrhythmia is a rhythm that bothers the patient. As a rule, if the patient’s ventricular rate is 60–100 beats per minute (regardless of mechanism), cardiac rhythm is not a problem.

2

State the goals in the treatment of cardiac dysrhythmias

The primary goal is to control ventricular rate between 60 and 100 beats per minute, and the secondary goal is to maintain sinus rhythm.

3

How important is sinus rhythm?

It depends on the patient’s ventricular function. Induction of atrial fibrillation in a medical student volunteer causes no measurable hemodynamic effect. Your ventricular compliance is so good that you do not need an atrial “kick” to fill the ventricle completely.

Conversely, the worse (the stiffer) the older patient’s heart, the more you should try to maintain sinus rhythm. We observed a patient with a 7% left ventricular (LV) ejection fraction (EF) whose cardiac output (CO) decreased by 40% when he postoperatively developed atrial fibrillation.

4

Do you need to be ankle deep in electrocardiogram paper and be personally acquainted with Drs Mobitz, Lown, and Ganong to treat cardiac dysrhythmias in the intensive care unit (ICU)?

No.

5