acute coronary syndromes
chronic CAD / LV dysfunction
coronary artery bypass surgery
Arrhythmias associated with ACS
Routine use of anti-arrhythmic drugs is not recommended following MI.
Patients who have suffered a recent myocardial infarction and with LVEF ≤ 0.40 and either diabetes or clinical signs of heart failure should receive eplerenone unless contraindicated by the presence of renal impairment or high potassium levels.
Arrhythmias associated with chronic CHD / decreased LVEF
Choice of antiarrhythmic drug
Rate vs rhythm control
Arrhythmias associated with chronic CHD/decreased LVEF
Rate control is the recommended strategy for management of patients with well tolerated atrial fibrillation.
Ventricular rate in AF should be controlled with beta blockers, rate-limiting calcium channel blockers (verapamil or diltiazem), or digoxin.
Digoxin does not control rate effectively during exercise and should be used as first line therapy only in people who are sedentary, or in overt heart failure.
Patients with AF who remain symptomatic despite adequate rate control should be considered for rhythm control.
Amiodarone or sotalol treatment should be considered where prevention of atrial fibrillation recurrence is required on symptomatic grounds.
Patients with atrial fibrillation who are severely symptomatic despite optimum tolerated medical therapy should be referred to a cardiac rhythm specialist for consideration of non-pharmacological therapy, e.g. radiofrequency ablation.
Implantable Cardioverter Defibrillators in primary and secondary prevention
Antiarrhythmic drug therapy
Patients with moderate to severe LV dysfunction (e.g. ejection fraction <0.35), in NHYA Class I-III at least one month after myocardial infarction should be considered for ICD therapy.
Patients with spontaneous non-sustained ventricular tachycardia (especially if sustained ventricular tachycardia is inducible), severely impaired ejection fraction (<0.25) or prolonged QRS complex duration (>120ms) should be prioritised for ICD implantation.
Patients meeting criteria for ICD implantation who have prolonged QRS duration (>120ms) and NYHA class III-IV symptoms should be considered for CRT-D therapy...