Concept of the five ′A′s for treating emergency arrhythmias

Abstract

Cardiac rhythm disturbances such as bradycardia (heart rate < 50/min) and tachycardia (heart rate > 100/min) require rapid therapeutic intervention. The supraventricular tachycardias (SVTs) are sinus tachycardia, atrial tachycardia, AV-nodal reentrant tachycardia, and tachycardia due to accessory pathways. All SVTs are characterized by a ventricular heart rate > 100/min and small QRS complexes (QRS width < 0.12 ms) during the tachycardia. It is essential to evaluate the arrhythmia history, to perform a good physical examination, and to accurately analyze the 12-lead electrocardiogram. A precise diagnosis of the SVT is then possible in more than 90% of patients. In ventricular tachycardia (VT) there are broad QRS complexes (QRS width > 0.12 s). Ventricular flutter and ventricular fibrillation are associated with chaotic electrophysiologic findings. For acute therapy, we will present the new concept of the five ‘A's, which refers to adenosine, adrenaline, ajmaline, amiodarone, and atropine. Additionally, there are the ‘B,’ ‘C,’ and ‘D’ strategies, which refer to beta-blockers, cardioversion, and defibrillation, respectively. The five ‘A’ concept allows a safe and effective antiarrhythmic treatment of all bradycardias, tachycardias, SVTs, VT, ventricular flutter, and ventricular fibrillation, as well as of asystole.

Cardiovascular complications during anaesthesia for surgical correction of an aberrant right subclavian artery in a dog

“…In addition, atropine increases firing of the sinoatrial node and conduction through the atrioventricular node, which explains its efficacy for treating the arrhythmia in the present case. 16 Other potentially preferential agents for use during an AVB, such as isoproterenol, could have been used if atropine had not been effective, which could have been the case if the breakdown in signal transmission was in the bundle of His/Purkinje fibres.…”

An overview of brady dysrhythmias in the emergency department

“…However, with a low Purkinje or ventricular escape rhythm and third-degree heart block, it is typically ineffective. 17 Despite of being a significant prevalent condition in the emergency department studies addressing the management of bradydysrhythmias in literature are quite limited and scarce hence advocating strong need of further clinical research which can also aid in development of effective management strategies of bradyarrythmias generating optimal outcomes.…”

Unaufhörliche oder rezidivierende ventrikuläre Tachykardien

“…Eine vorbestehende Therapie mit Klasse-IcAntiarrhythmika kann über einen proarrhythmischen Effekt die ventrikuläre Tachykardie perpetuieren und muss deshalb beendet werden. Auch Lidocain sollte nicht mehr verwendet werden [18].…”