MANAGEMENT OF POSTOPERATIVE ATRIAL ARRHYTHMIAS

Posted by e-Medical PPT Wednesday, January 1, 2014
POSTOPERATIVE  ARRHYTHMIAS
Proarrhythmic factors:
Autonomic nervous system
Hypokalemia
Hypomagnesemia
Myocardial ischemia
Myocardial Infarction
Proarrhythmic drugs

Narrow-complex tachycardias:
Sinus tachycardia
Atrial fibrillation
Atrial flutter
Accelerated junctional rhythm
Paroxysmal supraventricular tachycardia
Ectopic atrial tachycardia

SINUS  TACHYCARDIA
Causes:
Pain, anxiety
Surgical stress
Low cardiac output
Hypovolemia
Myocardial ischemia
Catecholamine administration

Treatment:
Treatment directed at the underlying cause
Must be distinguished from other narrow-complex tachycardias
Atrial electrogram (AEG) when diagnosis is uncertain
    Connect the left & right arm ECG cables to the atrial pacing wires
    Alternatively, connect the V lead to one atrial pacing wire

Atrial Electrogram (AEG):
AEG are useful for differentiating supraventricular arrhythmias.
Atrial fibrillation with RVR > 150 bpm, the rhythm may be misdiagnosed as paroxysmal SVT.
Atrial flutter: atrial activity may not be obvious on the surface ECG.
In patients with preexisting bundle-branch block, the development of a postoperative SVT may be difficult to distinguish from VT.
An accurate diagnosis can be readily made if an atrial electrogram (AEG) is recorded.
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