Dr (Mrs) D.S.GunawardenaDr (Mrs) D.S.Gunawardena
Consultant Cardiac ElectroPhysiologistConsultant Cardiac ElectroPhysiologist
&&
 
 
R e g u l a r I r e g u l a r  
N a r r o w C o m p l e x T . C .
Q R S < 0 . 1 2 s
R e g u l a r I r e g u l a r  
B r o a d C o m p l e x T . C .
Q R S > 0 . 1 2 s
T a c h y a r r h y h m ! a s
> 1 0 0 " p m
B r a d y a r r h y h m ! a s
< # 0 " p m
R h y h m $ ! s o r d e r s
CLASSIFICATION
 
 
Not in SR  Ventricular tachycardia SVT with BBB
 
 
 Vogel maneuvers
IV Verapamil
Beta Blockers
IV Amiodarone
 
Maximum u" to 1 mg
 
 
 
 block) block)
SUGGESTIVESUGGESTIVE FEATURESFEATURES
 
 
•CPRCPR
 
•DC cardioversion during CPRDC cardioversion during CPR
•If arrhythmia recurs or continues,If arrhythmia recurs or continues,
IV antiarryhthmicsIV antiarryhthmics
antiarrhythmicsantiarrhythmics
 *&idosis *&idosis
 #s&!aemia#s&!aemia
 +le&trolte imbala&es, &orre&tio+le&trolte imbala&es, &orre&tio
o- /o- / Mg2/ ad a2/Mg2/ ad a2/
 
Polymorphic VT/TorsadesPolymorphic VT/Torsades
 
 
 
 
Differential Diagnosis
• AF with antegrade conduction of accessory pathways
 
+
 
 
•Duration of AF is more than 48 hours
 With iv Heparin before DC shock
•followed by Warfarin for 4 weeks
 
Other indications
1.is' -a&tors -or &erebro vas&ular a&&idets
2.%e-ore ad a-ter ele&tive &ardio  versio
 
 
using rate control drugs
If accessory pathway isIf accessory pathway is
suspectedsuspected
 blockers blockers
Classification of Bradyarrhythmias
lobal ds-u&tio o- t!e &odu&tio sstem
 *sstole
"er'alaemia or "o'alaemia 
 
 
 
e.g. Hypoxia, Electrolytes, Ischemia,
 
 
Correction of reversible factorsCorrection of reversible factors
 
 Acute Myocardial Infarction
Long QT syndrome
**ExceptExc
•HypotensionHypotension
•MONOPHASIC DEFIBRILLATORMONOPHASIC DEFIBRILLATOR
•BIPHASIC DEFIBRILLATORBIPHASIC DEFIBRILLATOR
 
 
SHOCKSHOCK
recognised QRS complexesrecognised QRS complexes
 
REASONS TO GIVEREASONS TO GIVE SYNCHRONIZED DC SHOCKSYNCHRONIZED DC SHOCK
  To avoid falling of shock wave onTo avoid falling of shock wave on
 vulnerable period of the T wave vulnerable period of the T wave
 To prevent occurrence of To prevent occurrence of
 ventricular arrhythmias ventricular arrhythmias
 
HOW TO SELECT THEHOW TO SELECT THE  AMOUNT OF JOULES AMOUNT OF JOULES 
 According to the latest According to the latest
guidelinesguidelines77
““In cardiac arrestIn cardiac arrest consider highest amount ofconsider highest amount of
 joules joules””
 
HOW TO SELECT THEHOW TO SELECT THE  AMOUNT OF JOULES AMOUNT OF JOULES 
• Atrial flutter 25- 50 J Atrial flutter 25- 50 J
• Atrial fibrillation 200J Atrial fibrillation 200J
•Slow VT 200J onwardsSlow VT 200J onwards