Tachycardia: Difference between revisions

In a acute episode a patient with an AFT requires cardioversion. This can be achieved with anti-arrhythmic drugs or electrical cardioversion. Vagal maneuvers increase the AV-block on the ECG and demonstrate the AFT more clearly. Anti-arrhythmic drugs are modestly effective in the acute setting (ibutilide or dofetilide), but have the risk of pro-arrhythmic effects.<cite>Volgmann, Singh, Stambler</cite> DC cardioversion is an effective methods to cardiovert AFT, especially in patients with heart failure or hemodynamic instability. AFT is amendable to catheter ablation and this is the treatment of choice in AFT. Targeted ablation of the area between the inferior vena cava and the tircuspid annulus can block the re-entry circuit. This is a very successful procedure, with few complications in the hands of an experienced electrophysiologist.<cite>Kottkamp, Natale, Chen4</cite> If patients are not eligible for ablation, anti-arrhythmic drugs class IC or III can be started. However they are of limited efficacy and class IC drugs not be administered without AV-nodal slowing agent because of atrial slowing can result in 1:1 AV conduction. Patients with AFT require anti-coagulation as in atrial fibrillation according to the CHADSVASc score.<cite>Dunn, Lip5</cite>