Table 12 Open in new tab Peri-operative...

Table 12

Peri-operative management of patients with arrhythmias

Type of arrhythmia	SVT	Idiopathic VT in structurally/functionally normal heart	VT in structural heart disease
Diagnostics	ECG ± TTE^a	ECG ± TTE	ECG + TTE + biomarkers^b ± Coronary angiography ± Cardiac CT/MRI
Acute management	Vagal manoeuvres I.v. adenosine, beta-blocker, CCB Electrical cardioversion if unstable	Vagal manoeuvres I.v. beta-blockers/ verapamil Electrical cardioversion if unstable	Treatment of underlying heart disease I.v. beta-blocker (uptitration), amiodarone Electrical cardioversion if unstable
Prevention of recurrence	Per oral beta-blocker, CCB Catheter ablation if recurrent despite OMT (only before high-risk NCS)	No treatment or Per oral beta-blocker, CCB, class I AAD Catheter ablation in case of recurrence despite AADs or drug-intolerance before high-risk NCS	Per oral beta-blocker, amiodarone Catheter ablation if recurrent despite OMT

Type of arrhythmia	SVT	Idiopathic VT in structurally/functionally normal heart	VT in structural heart disease
Diagnostics	ECG ± TTE^a	ECG ± TTE	ECG + TTE + biomarkers^b ± Coronary angiography ± Cardiac CT/MRI
Acute management	Vagal manoeuvres I.v. adenosine, beta-blocker, CCB Electrical cardioversion if unstable	Vagal manoeuvres I.v. beta-blockers/ verapamil Electrical cardioversion if unstable	Treatment of underlying heart disease I.v. beta-blocker (uptitration), amiodarone Electrical cardioversion if unstable
Prevention of recurrence	Per oral beta-blocker, CCB Catheter ablation if recurrent despite OMT (only before high-risk NCS)	No treatment or Per oral beta-blocker, CCB, class I AAD Catheter ablation in case of recurrence despite AADs or drug-intolerance before high-risk NCS	Per oral beta-blocker, amiodarone Catheter ablation if recurrent despite OMT

AAD, antiarrhythmic drug; CCB, calcium channel blocker; CT, computer tomography; ECG, electrocardiogram; MRI, magnetic resonance imaging; NCS, non-cardiac surgery; OMT, optimal medical therapy; SVT, supraventricular tachycardia; TTE, transthoracic echocardiography; VT, ventricular tachycardia.

Before high-risk surgery.

High-sensitivity cardiac troponin T/I, and/or BNP/ N-terminal pro-BNP.

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