Treatment of life-threatening cardiac arrhythmias

Tachyarrhythmias represent a frequent problem in intensive care medicine. However, considerable uncertainty prevails among physicians regarding optimal pharmacotherapy, due also to numerous negative study results on chronic antiarrhythmic therapy. Moreover, in an emergency situation, the physician faces the dilemma of treating a potentially life-threatening arrhythmia as quickly as possible while simultaneously ensuring adequate diagnostic work-up, which will be decisive for long-term therapy once the patient has survived the crisis. The differential diagnosis between supraventricular and ventricular tachycardias is primarily facilitated by knowledge of a few salient points from the patients history and 12-lead electrocardiography. This overview presents the most important principles for treating these arrhythmias. Interventional therapy principles (overstimulation, ablation) play an increasing role in these considerations. New insights on the pathogenesis of "malignant" arrhythmias and implementation of new concepts such as defibrillation by lay responders with the automatic external defibrillator will substantially influence emergency treatment of tachyarrhythmias in the coming years.