Treatment of tachyarrhythmias

A Randomized Controlled Trial of Magnesium Sulfate, in Addition to Usual Care, for Rate Control in Atrial Fibrillation

“…Published reviews of the management of atrial fibrillation have examined the evidence for the use of the pharmacologic agents commonly used to treat rapid atrial fibrillation. 4,6,7 Broad consensus is seen in the recommendations of these reviews insofar as they recommend that calcium-channel blockers and b-blockers be considered first-line agents for rate control in patients with preserved left ventricular function, but caution their use in the presence of poor left ventricular function. We believe that many emergency physicians use digoxin despite its slow onset of effect because of uncertainty of their patients' underlying cardiac status.…”

“…For this group, digoxin or amiodarone has been recommended. 4,6,7 Digoxin has recently been the mainstay of therapy, and although inexpensive, it has a slow onset of action and is significantly less effective in states of increased sympathetic tone. 4,6,[8][9][10] Despite the widespread use of amiodarone in this setting, the evidence for its efficacy is somewhat equivocal.…”

Antidysrhythmic drug therapy for the termination of stable, monomorphic ventricular tachycardia: a systematic review

“…Despite all the changes and the differences between European and US guidelines, direct-current cardioversion remains the most effective therapy 11 12. The most recent revision of AHA guidelines is based on few studies, some of which are retrospective in design 8 9 13 14.…”

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

“…This can be achieved with cardioversion, antiarrhythmic medications, or pacing techniques. DC cardioversion even at early stage or as "first line" is reasonable (359,360). Advantages include the absence of proarrhythmia and high efficacy in a timely fashion.…”