Prepared by dr Akram Sa,adeh Attended by dr Ali Al Halabi

Prepared by dr Akram Sa,adehAttended by dr Ali Al Halabi Arrhythmias

Introduction • Ped. Arr. May be transient or permanent cong. Or acquired caused by atoxin or drugs surgery metabolic disorders fetal infl.

The major risk: • Severe tachy. Or brady. may lead to : Syncope Sudden death when apt. has an arr. It is vital to determine whether is prone to deteriorate into alife threatening tachy. Or brady.

management • 1. Pharmacologic agents. • 2. Transcath. radiofrequency ablation . • 3. Implantable pacemackers. • 4. Implantable cardioverter-defibrillators (ICDs).

Antiarr. drugs • Problems with frequency ,copliance, S.E.,drug interactions ,and variable responses remain,and selection of a druginvolves empiricism. single vs multiple agents route.

DRUG INDICATION SE INTERACTIONCLASS1A

DRUG INDICATION SE INTERACTION

SINUS ARR. • Represents a normal physiologic variation in impulse discharges from the sinus node related to respirations. • If the sinus rate is slow enough ,an escape beat arises from the AV junc.

Irregularities in sinus r commonly seen in premature infants . • Exaggerated by :febrile illnesses drugs Abolished by :ex. SINUS BRADY: due to slow discharge of impulses from the sinus node. Insignificant in athletes. Indicates sys. Dis., as myxedema.

Sinus brady must be diff. From SA and AV block. • LBWI display great variation in sinus rate. • Sinus brady is com. And may be ass. With junc. Escape beats. • PACs r also com. • Sleep. • RX.

Wandering atrial pacemaker • An intermittent shift in the pacemaker from the sinus node to an another part of the atrium. • Not uncom. Usually represents a normal varient, but may be seen in CNS disturb. Eg:SAH.

Extrasystoles ……………… • by discharge of an ectopic focus . Usually isolated extrasystoles r of no clinical or prognostic significance . May be due to :organic heart dis. :drug toxicity.

PAC • Common ,even in the absence of cardiac dis. • PAC may result in: normal :prolonged(aberrancy) :absent(blocked premature atrial comlexes). Depending on: the degree of prematurity of the beat(coupling interval. the preceding R-R interval(cycle length)

Absent QRS complex occ. When premature impulse is conducted to the ventricle while the specialised vent. Conducting sys is partially refractory. • Premature P wave preceding the QRS that has adiff. Contour is ess. For the dx. • PAC often reset the sinus node pacemaker

PVCs • May arise from any region of the ventricles. • Premature widend ,bizzare QRS complexes that r not preceded by a p wave. • Unifocal or Multifocal. • Often,followed by a compensatory pause.

The presence of fusion beats ,that is,complexes with morphologic features that r intermediate between those of normal sinus beats and those of PVCs , is a clue to the ventricular origin of the extrasystole. Extrasyst. Produce a small stroke and pulse vol. than normal and if quite premature may not be audible with a stethoscope or palpable ay the radial pulse.

Most pt r unaware of asingle PVC . • Some pt may be aware of a skipped beat over the precordium due to inc. Stroke vol of a normal beat following a compensetory pause. • Anxiety ,a febrile illness,or ingestion of various drugs or stimulants may cause PVCs.

Benign PVCs. vs • PVCs likely to degenerate into severe arr. • Indications for further inv. of PVCs that could require suppressive therapy: 1 . 2 or more PVCs in a row. • Multifoal origin. • Inc. vent ectopic activity with ex.

4. R on T 5. Presnce of underlying h dis.

Rx • reassurance • Malig. PVCs are secondary. .underlying cond. .lidocaine. .amiodarone. .maintainance.

Prepared by dr Akram Sa,adeh Attended by dr Ali Al Halabi