Cardiac Electrophysiology Consultants of South Texas, P.A.

Medical Center Tower I
7950 Floyd Curl Drive
Suite 803
San Antonio, TX 78229
tel: 210-615-9500
fax: 210-615-9600
email: office at cecst.com
 Specializing in the compassionate care of people who suffer from abnormalities of the electrical system of the heart Current Insurance Plans: We accept most major commercial insurance plans. Please call for details.
Medicare: We have opted out of Medicare, and are happy to care for Medicare beneficiaries on an affordable cash basis. Note: Federal law prohibits signing the Federally-mandated opt-out contract with a Medicare beneficiary who is in an emergency situation.
No insurance? No problem! Consider our affordable Fee for service (direct pay).
Home of the Original Personalized Medical Office SystemTM released April 5, 2013

General information about the heart for patients, their family members, and concerned laymen

Electrographic Rhythms
     We have an extensive list of electrocardiographic rhythms contains brief patient_forum of pathophysiology, clinical setting, diagnosis and treatment.
Antiarrhythmic Medications
     There are about eight types of antiarrhythmic drugs on the market in the U.S.A. These include the classic Vaughn-Williams classification, digitalis, and adenosine. They are:
  • VW Class IA

  • VW Class IB

  • VW Class IC

  • VW Class II (beta blockers)

  • VW Class III (amiodarone, sotalol)

  • VW Class IV (calcium blockers)

  • Digitalis

  • Adenosine
Proarrhythmia
     Proarrythmia is an undesirable side-effect seen with antiarrhythmic and some other types of drugs, in which worsened arrhythmias are seen. These are usually ventricular tachyarrythmias, and can be fatal. This side effect is seen more frequently in patients who have damaged myocardium and reduced left ventricular ejection fraction.

The most malignant form of proarrhythmia is polymorphic ventricular tachycardia. The occurrence of this rhythm is frequently preceded by prolongation of the QT interval and then by short runs of multiform PVCs.

Drugs that Cause Atrioventricular Nodal Blockade
     Treatment of tachyarrhythmias frequently requires pharmacologic induction of partial blockade of the atrioventricular node. Such rhythms include atrial fibrillation and atrial flutter.

Several drugs may be used for this purpose. For short-term treatment,

  • intravenous esmolol is safe in most patients because it is has a very short half life. But, it is administered in a relatively large volume, which can be troublesome in a patient prone to congestive heart failure, and it requires continuous administration for long term control.

  • verapamil may be given intravenously in small boluses every few minutes, with careful attention to the blood pressure. Once a therapeutic effect is achieved, the drug is given every four to six hours.

    • DO NOT give verapamil to patients with wide complex tachycardia. It can kill the patient with ventricular tachycardia by reducing systemic vascular resistance at a time when the heart cannot generate a compensatory increase in cardiac output.

    It can also accelerate conduction over an accessory pathway. If the patient is in atrial fibrillation, the increase in ventricular response can initiate ventricular fibrillation.

    Pretreatment with intravenous calcium chloride has been reported to reduce the incidence of hypotension, and can also be used to treat hypotension induced by verapamil.

  • diltiazem can be given intravenously. When given intravenously, it is generally safer than intravenous verapamil.

  • digoxin can be given intravenously with good results, but takes longer to achieve a therapeutic effect than do the agents mentioned above. DO NOT give digoxin during wide complex tachycardia. It can also accelerate conduction over an accessory pathway. If the patient is in atrial fibrillation, the increase in ventricular response can initiate ventricular fibrillation.

  • Oral verapamil, diltiazem, beta blockers, and digoxin are relatively safe and effective, but take longer to achieve therapeutic levels than when administered intravenously.

For information, email webmaster@cecst.com
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