Cardiac Arrhythmias

  • Robert L. Hatch
  • Ken Grauer
  • John G. Gums


Cardiac arrhythmias are encountered frequently in primary care settings. Because of their diverse nature and the volume of information available, an extensive discussion of this topic is beyond the scope of this chapter. The discussion here focuses on the most important aspects of the outpatient management of common cardiac arrhythmias. The goal of this chapter is to present a practical, step-by-step approach to their diagnosis and management. In general, the discussion applies only to adult patients.


Atrial Fibrillation Sinus Rhythm Ventricular Arrhythmia Atrial Flutter Antiarrhythmic Agent 
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  1. 1.
    Baerman JM, Morady F, DiCarlo LA, de Buitleir M, Arbor A. Differentiation of ventricular tachycardia from supraventricular tachycardia with aberration: value of the clinical history. Ann Emerg Med 1987; 16(1): 40/63–43/66.PubMedCrossRefGoogle Scholar
  2. 2.
    Grauer K, Cavallaro D. ACLS: a comprehensive review. Vol. II. 3rd ed. St. Louis: Mosby Year Book, 1993.Google Scholar
  3. 3.
    Roberge R, Anderson E, MacMath T, Rudoff J, Luten R. Termination of paroxysmal supraventricular tachycardia by digital rectal massage. AnnEmerg Med 1987;16:1291/139–1293/141.Google Scholar
  4. 4.
    Camm AJ, Garratt CJ. Adenosine and supraventricular tachycardia. N Engl J Med 1991;325:1621–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Stroke Prevention in Atrial Fibrillation Study Group Investigators. Preliminary report of the stroke prevention in atrial fibrillation study. N Engl J Med 1990;322:863–8.Google Scholar
  6. 6.
    Falk RH, Knowlton AA, Bernard SA, Gotlieb NE, Battinelli NJ. Digoxin for converting recent-onset atrial fibrillation to sinus rhythm: a randomized, double-blinded trial. Ann Intern Med 1987;106:503–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Falk RH, Leavitt JI. Digoxin for atrial fibrillation: a drug whose time has gone? Ann Intern Med 1991;114:573–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Dunn M, Alexander J, de Silva R, Hildner F. Antithrombotic therapy in atrial fibrillation. Chest 1986;89:865–745.Google Scholar
  9. 9.
    Coplen SE, Antman EM, Berlin JA, Hewitt P, Chalmers TC. Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion: a meta-analysis of randomized control trials. Circulation 1990;82:1106–16.PubMedCrossRefGoogle Scholar
  10. 10.
    Wolf PA, Dawber TR, Thomas HE Jr, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology 1978;28:973–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Grauer K. Anticoagulation in atrial fibrillation. Am Fam Physician 1992;45:2494–5.Google Scholar
  12. 12.
    The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation: the Boston Area Anticoagulation Trial for Atrial Fibrillation investigators. N Engl J Med 1990;323:1505–11.Google Scholar
  13. 13.
    Chesebro JH, Fuster V, Halperin JL. Atrial fibrillation—risk marker for stroke. N Engl J Med 1990;323:1556–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Kennedy HL, Whitlock JA, Sprague MK, Kennedy LJ, Buckingham TA, Goldberg RJ. Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med 1985;312:193–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Morganroth J. Premature ventricular complexes; diagnosis and indications for therapy. JAMA 1984;252:673–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Hallstrom AP, Cobb LA, Ray R. Smoking as a risk factor for recurrence of sudden cardiac arrest. N Engl J Med 1986;314:271–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Increased mortality due to encainide or flecainide in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989;321:406–12.CrossRefGoogle Scholar
  18. 18.
    CAST II Investigators. Effect of the antiarrhythmic agent moriciz-ine on survival after myocardial infarction. N Engl J Med 1992;327:227–33.CrossRefGoogle Scholar
  19. 19.
    Morganroth J, Goin JE. Quinidine-related mortality in the short-to-medium-term treatment of ventricular arrhythmias: a meta-analysis. Circulation 1991;84:1977–83.PubMedCrossRefGoogle Scholar
  20. 20.
    Ruskin JN, McGovern B, Garan H, DiMarco JP, Kelly E. Antiarrhythmic drugs: a possible cause of out-of-hospital cardiac arrest. N Engl J Med 1983;309:1302–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Grauer K, Leytern B. A systematic approach to Holter monitor interpretation. Am Fam Physician 1992;45:1641–8.PubMedGoogle Scholar
  22. 22.
    Grauer K, Gums J. Ventricular arrhythmias. Part II. Special concerns in evaluation. J Am Board Fam Pract 1988;1:201–6.PubMedGoogle Scholar
  23. 23.
    Hallstrom AP, Cobb LA, Yu BH, Weaver WD, Fahrenbruch CE. An antiarrhythmic drug experience in 941 patients resuscitated from an initial cardiac arrest between 1970 and 1985. Am J Cardiol 1991;68:1025–31.PubMedCrossRefGoogle Scholar
  24. 24.
    Balady GJ, Cadigan JB, Ryan TJ. Electrocardiogram of the athlete: an analysis of 289 professional football players. Am J Cardiol 1984;53:1339–43.PubMedCrossRefGoogle Scholar
  25. 25.
    Brodsky M, Wu D, Denes P, et al. Arrhythmias documented by 24-hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease. Am J Cardiol 1977;39:390.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • Robert L. Hatch
  • Ken Grauer
  • John G. Gums

There are no affiliations available

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