Cardiac Arrhythmias

· Sinus rhythm – normal heart rhythm.

· Arrhythmia – deviation from sinus rhythm.

· Tachycardia – increased heart rate.

· Bradycardia – decreased heart rate.

· Flutter – when select portions are slightly out of sync with the rest of the heart.

· Fibrillation – large portions of the heart beat are out of sequence.

      • Ventricular fibrillation – no blood flows through the heart

2. Drug Regimens and Treatments:

Medications for arrhythmias are designed to restore normal sinus rhythm.

Antiarrhythmic drugs are chosen and dosed individually and are categorized into classes
based on their mechanisms of action.
Different drug classes:

Class I: Membrane-Stabilizing Agents

Membrane-stabilizing agents (Class I) include medications that block sodium channels in cardiac
muscles.

Slowing the influx of sodium allows the cell membrane to become more stable and less able to
depolarize.

The electrical charge must be stronger to stimulate the cardiac muscle cells to contract and make
the heart beat.

Side effects are drug specific. Contraindications are numerous and drug specific.

Antiarrhythmic drugs should be used with caution.

Class II: Beta Blockers

Some beta blockers inhibit beta-1 receptors; which inhibit sympathetic nervous system activity on
the heart; slowing conduction through the AV node; slowing rate and force of heartbeats just enough
to reduce arrhythmias.

Side effects are drug specific.

Beta blockers are contraindicated in bradycardia, cardiogenic shock, and heart block.

Sotalol should be used with caution.

Class III: Potassium-Channel Blockers

Potassium-channel blockers block potassium channels in cardiac muscle cells.
These drugs work by slowing the influx of potassium, which makes the cell membrane more stable
and less able to depolarize. Electrical charge must be stronger to make the heart beat; regulating
heart rhythm because it decreases the incidence of abnormal beats.

Side effects are drug specific. Amiodarone has contraindications, along with dofetilide.

Cautions and considerations are drug specific.

Class IV: Calcium-Channel Blockers

Diltiazem and verapamil are frequently used for atrial fibrillation. These drugs block calcium from
entering cardiac muscle cells; dilating cardiac arteries, providing better oxygen supply.

Side effects are drug specific.

Diltiazem should not be used in patients with sick sinus syndrome, secondary or third-degree AV
block, severe low blood pressure, acute heart attack, and pulmonary congestion.

Verapamil in IV form should not be used in patients taking beta blockers and those with ventricular
tachycardia. Antiarrhythmic drugs should be used with caution.