Clinical Heart and Vascular Center

Arrhythmias in the Intensive Care Unit: Acute SVT Management

By Jose Joglar, M.D.

Professor of Internal Medicine

Director of Cardiology

President, Medical Staff, Parkland Health & Hospital System

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Dr. Jose Joglar

Cardiac arrhythmias are seen in up to 20% of patients in the intensive care unit (ICU) and are considered a major source of morbidity. Therefore, understanding how to prevent and manage these arrhythmias is of paramount importance. It was my pleasure to participate in a #AHA20 session titled “Code Blue: Arrhythmia Management in the Critical Care Setting.” This was a particularly important session from the clinical standpoint, as updates on clinical management of arrhythmias in the ICU were discussed by speakers from around the world. The lectures included: “Acute Management Strategies for Ventricular Tachycardia Storm,” “Postoperative Atrial Fibrillation – Benign Sequelae or Predictor of Future Risks,” “Prevention of Postoperative Atrial Fibrillation,” and “Improving Cognitive Survival of the Post-Arrest Patient – 2020.” I also presented a talk titled “Update on Acute SVT Management.”

“Both SVTs and AF are considered markers of disease severity, seen in patients with severe sepsis or receiving vasopressor agents, as well as a likely contributor to poor outcomes. The most important therapeutic goal is aimed at improving the underlying critical illness.”

Jose Joglar, M.D.

Supraventricular tachycardia (SVTs) are often seen in the critically ill, and atrial fibrillation (AF) is the most common arrhythmia. Both SVTs and AF are considered markers of disease severity, seen in patients with severe sepsis or receiving vasopressor agents, as well as a likely contributor to poor outcomes. The most important therapeutic goal is aimed at improving the underlying critical illness. In terms of treatment strategies, cardioversion is generally not recommended in view of its high relapse rate. Of the drugs discussed, beta blockers were deemed a good first option, especially esmolol, a therapy that has been shown to improve outcomes in this population. IV amiodarone was deemed an effective second-line option, while the potential benefit of other drugs such as propafenone were discussed. Additional research is needed to address other questions, such as the role of anticoagulation in critically ill patients with AF.

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