Table 3. The acute treatment of newly arising perioperative cardiac arrhythmias.
| Perioperative arrhythmia | Treatment |
| Supraventricular arrhythmias | |
| – atrial tachycardia | – if hemodynamically relevant → electrical cardioversion, otherwise rate control – if spontaneous conversion does not occur, aim for arrhythmia control before discharge – further cardiological treatment |
| – AV node reentry tachycardia (AVNRT) / atrioventricular reentry tachycardia (AVRT) | vagal maneuvers – adenosine (caveat: adenosine should not be given to patients with antidromic AVRT) – if this fails and the arrhythmia is hemodynamically significant → electrical cardioversion. |
| – supraventricular extrasystoles | usually no immediate need for treatment |
| – atrial fibrillation | – anticoagulation in case of increased risk of thromboembolism (to be weighed against the risk of perioperative bleeding) – if hemodynamically significant → electrical cardioversion, otherwise rate control – if spontaneous conversion does not occur, rhythm control is generally advisable over the further course – further cardiological treatment |
| Ventricular arrythmias | |
| – atrial fibrillation | – cardiopulmonary resuscitation with defibrillation (and additional administration of catecholamines and amiodarone, as needed) – evaluate possible indication for immediate cardiac catheterization |
| – ventricular extrasystoles | usually no immediate need for treatment |
| – ventricular tachycardias | – monomorphic ventricular tachycardia: electrical cardioversion if hemodynamically significant; if not, amiodarone as initial treatment – polymorphic ventricular tachycardia: evaluate possible indication for immediate cardiac catheterization – torsade de pointes tachycardia: magnesium sulfate, correction of any electrolyte disturbances or drug triggers – in case of bradycardia, temporary pacemaker to raise the heart rate to 100–120/min |
| Bradycardias | |
| – high-grade AV block and sinus arrest | depending on the precipitating factors, duration and hemodynamic state: – watch and wait; anticholinergic agents (atropine) or sympathomimetic agents (orciprenaline) – temporary pacemaker for strict indications |