Pharmacological Theraphy in

Life threatening Arrhythmias

Rerdin Julario
Electrophysiology and Pacing Division
Dr Soetomo General Hospital
Surabaya
Improve Symptoms
Prevent a potential life threatening arrhythmias
Reduce other possible indirect risk ( ex. stroke in AF )
Among the most dangerous pharmacologic agents
Narrow therapeutic window
Most antiarrhythmic drug : proarrhythmic effect

3
Atropine
◦ Most effective for bradyarrhytmia early in Inferior MI (24 h)
◦ 0.5-1 mg to a total of 3 mg
◦ Prepare to give more fluids in inferior/RV infarction

Dopamin
◦ 2 to 10 mcg/kg/minute

Epinephrine
◦ 2 to 10 mcg/minute
Vaughan- Williams

5
Based on Channels and Receptors

6
7
8
9
10
11
Unclassified Drugs
Adenosine
Ivabradine
Digoxin

12
Tachyarrhythmia ACLS

13
Amiodarone
◦ Max recommended daily dose 2.2 g
◦ 300 mg rapid (unstable) or 150 mg 10 min (stable)
bolus then 300 mg/6 hours and 600 mg/18 hours
Lidocaine if Infarction or Ischemia
◦ 1-3 mg/kg bolus then maintenance 1-4 mg/min
Adenosine (stable narrow complex tachycardia)
◦ 6 mg, then 12 mg push

14
15
16
17
Pharmalogical theraphy depend underlying etiology
Beta blocker is preferrable arrhythmia drug
especially with CAD and Heart failue
Amiodarone should be the “last weapon” and short
term for management of serious life threatenings
arrhythmias

18
Thank you

19
20