Perioperative Tachyarrhythmias

Overview

Sudden onset of tachyarrhythmias in an operating theatre or an intensive care unit can be a frustrating experiencefor an attending physician and sometimes even for his patient, not only because of severity of patient’s clinical state,but also for the mental stress loaded on him by collaborating surgeons. From that reason, a diagnosis and treatmentof such condition should be intensive, simple, effective and safe for the patient. Increased activity of sympathoadrenalsystem is the main pathophysiological condition in the pathogenesis of perioperative arrhythmias that can provokesinus tachycardia followed with a transient myocardial ischaemia and other deleterious effects. Sympathetic nervoussystem stability plays an important role in the prevention and treatment of perioperative arrhythmias. In this reviewarticle, the author highlights a basic electrophysiology and molecular pathophysiology of heart rhythm disturbances,and on the background of recent clinical studies he tries to propose a simplified therapeutic algorithm for treatmentof these difficult states. Beta-blockers and group III. antiarrhythmics of Vaughan-Williams classification (amidarone)are recommended as the optimal remedies for the treatment of tachyarrhythmias in the perioperative period.

Key words:
amidarone, beta-blockers, dofetilide, ibutilide, clonidine, antiarrhytmic classifications, SicilianGambit, pathophysiology, arrhythmogenesis, antiarrhythmics, proarrhythmias, perioperative arrhythmias.