Arrhythmia: Presenter-Dr Praveen Kumar Moderator - DR Sandhya Chauhan
Arrhythmia: Presenter-Dr Praveen Kumar Moderator - DR Sandhya Chauhan
Arrhythmia: Presenter-Dr Praveen Kumar Moderator - DR Sandhya Chauhan
Classified as
Bradyarrhythmias
Atrial
Junctional
Ventricular
Heart Blocks
ELECTRICAL CONDUCTION
COMPONENTS:-
Sinoatrial (SA) node
Interatrial tract (Bachmann’s bundle)
Internodal tracts
Atrioventricular (AV) node
Bundle of His
Right and left bundle branches
Purkinje fibres
CONDUCTION PATHWAY:-
Tachyarrhythmias - Symptoms
Conducted to Not
ventricle with conducted
aberrant or to ventricle,
widened QRS apparent
complex pause NELSON TEXTBOOK OF PEDIATRICS 21st EDITION
Early p wave, sometimes with different morphology than a sinus p wave
4.WANDERING ATRIAL PACEMAKER
Pacemaker shifts from sinus node to another atrial site
Normal variant
Irregular rhythm
SVT in a child with WPW showing normal QRS complexes with P waves
seen on upstroke of T waves NELSON TEXTBOOK OF PEDIATRICS 21st EDITION
Typical features of WPW are apparent when tachycardia subsides
Wide QRS complexes, delta waves, short PR interval
Risk of sudden death NELSON TEXTBOOK OF PEDIATRICS 21st EDITION
Management of SVT:-
Uncommon in children
Variable HR, usually >200bpm
Due to a single focus of automaticity
On starting pharmacologic therapy, the tachycardia gradually slows
down only to speed up again
ECG shows ectopic p waves with an abnormal axis
Chaotic ECG pattern with multiple ectopic P waves with abnormal axes
NELSON TEXTBOOK OF PEDIATRICS 21st EDITION
JUNCTIONAL ECTOPIC
TACHYCARDIA:-
Due to an abnormal focus of automaticity
The focus being a conducting tissue very close to the AV node
(junctional)
Discharge of impulses from junctional tissue exceeds SA nodal discharge
leading to AV dissociation
Occurs in early post op period or may be congenital
IV amiodarone is the DOC for post-op JET
Congenital JET requires catheter ablation
Maintenance therapy with amiodarone/sotalol
NELSON TEXTBOOK OF PEDIATRICS 21st EDITION
ATRIAL FLUTTER:-
Also called intra-atrial re-entrant tachycardia
HR > 400-600 bpm in neonates, >250-300 bpm in children
Due to re-entrant pathway located in the right atrium circling the tricuspid
valve annulus
AV dissociation occurs and ventricles respond to 2nd - 4th atrial beat
Occurs in neonates with normal hearts and in children with
Rare in children
Digoxin toxicity, extensive atrial surgery
This digitalis toxic arrhythmia is a special type of ventricular tachycardia with QRS
complexes that alternate in direction from beat to beat. No P waves are present.
KDT PHARMACOLOGY 8TH EDITION
Atrial fibrillation with an excessively slow ventricular rate because of digitalis toxicity.
Atrial fibrillation with a rapid ventricular rate is rarely caused by digitalis toxicity.
A- B - C
Hydration with IV fluids, oxygenation and support of ventilatory
function, discontinuation of the drug, and, sometimes, the
correction of electrolyte imbalances.
Fab antibody fragments are extremely effective in the treatment of
severe, acute digitalis toxicity.
Cardiac glycosides undergo some degree of enterohepatic or
enteroenteric recirculation and are adsorbed to activated charcoal .
AC or multi-dose AC (MDAC) are recommended for digitalis
toxicity .
KDT PHARMACOLOGY 8TH EDITION
Management of arrhythmia:-
In case of tachycardia: give lidocaine or phenytoin (No effect on AV
conduction).
Life-threatening ventricular arrhythmias are treated according to the
algorithms of advanced cardiac life support (ACLS).
In case of bradycardia: give atropine.
Correct electrolyte disturbances
In case of hyperkalemia: give EDTA and give insulin + glucose to shift
K+ intracellularly But Ca gluconate is contraindicated.
However, hyperkalemia itself does not cause death, and treatment with
potassium-lowering agents does not reduce mortality.
KDT PHARMACOLOGY 8TH EDITION
DIGIFAB:-
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