1st February 2007
Scottish Intercollegiate Guidelines Network
Summary,

Source: National Guidelines Clearinghouse

GUIDELINE OBJECTIVE(S)

To provide evidence-based recommendations for the management of cardiac arrest and the arrhythmias associated with acute coronary syndromes, chronic coronary heart disease and cardiac surgery

TARGET POPULATION

Adult patients with cardiac arrhythmias associated with acute coronary syndromes, chronic coronary heart disease and cardiac surgery

INTERVENTIONS AND PRACTICES CONSIDERED

Management/Prevention/Treatment

Arrhythmias Associated with Cardiac Arrest

1. Risk factor intervention
2. Health promotion measures and encouragement of moderate intensity physical activity
3. Cardiopulmonary resuscitation (CPR) training
4. Prompt defibrillation, including use of automated external defibrillators
5. Adjunctive therapies including adrenaline (epinephrine), amiodarone, procainamide, sotalol, magnesium, potassium, isoprenaline, dopamine, atropine, aminophylline, temporary transcutaneous pacing, or withdrawal of QT-interval-prolonging drugs

Arrhythmias Associated with Acute Coronary Syndromes

1. Synchronized direct current (DC) cardioversion
2. Anti-arrhythmic and rate limiting therapy with intravenous amiodarone, beta-blockade, verapamil, or digoxin
3. Discontinuation of concurrent therapies which predispose to bradycardia in patients with conduction disturbances and bradycardia
4. Initiation of transvenous or transcutaneous temporary pacing or permanent pacing in selected patients
5. Risk assessment and optimisation of therapy for patients with ventricular fibrillation (VF) or VT
6. Treatment of selected patients with myocardial infarction (MI) with eplerenone, as indicated
7. Assessment of left ventricular (LV) function in patients with acute MI

Arrhythmias Associated with Chronic Coronary Heart Disease/Left Ventricular Dysfunction

Atrial Fibrillation

1. Amiodarone or sotalol treatment for prevention of atrial fibrillation recurrence
2. Rate control with beta-blockers, rate-limiting calcium channel blockers, or digoxin, or a combination of drugs
3. Rate control with ablation and pacing

Ventricular Arrhythmias

1. Revascularisation
2. Implantable cardioverter defibrillator therapy (ICD)
3. Cardiac resynchronisation therapy + defibrillator (CRT-D)
4. Long term use of beta-blockers
5. Treatment with amiodarone or sotalol in selected patients

Arrhythmias Associated with Coronary Artery Bypass Graft Surgery

1. Assessment of risk for postoperative arrhythmia
2. Pharmacological therapy with amiodarone, beta-blockers, verapamil, diltiazem, magnesium, as indicated
3. Use of glucose-insulin-potassium regimens (not recommended)
4. Use of digoxin prophylaxis (not recommended)
5. Consideration of anesthetic agent or technique
6. Consideration of surgical techniques
7. Synchronised cardioversion for patients with atrial fibrillation
8. Defibrillation for patients with ventricular arrhythmias

Psychosocial Assessment, Screening, and Management

1. Screening for anxiety or depressive disorders
2. Selective cognitive screening
3. Consideration of psychosocial implications
4. Psychosocial interventions

MAJOR OUTCOMES CONSIDERED

• Sudden cardiac death
• Short-term, long-term, and in-hospital mortality
• Survival
• Quality of life
• Recurrence of arrhythmia
• Heart rate control
• Ejection fraction
• Symptomatic and functional status
• Return of spontaneous recirculation
• Restoration of sinus rhythm
• Cost effectiveness
• Psychosocial outcomes, including levels of anxiety and depression