Arrhythmias post MI

Arrhythmias post-MI (treat all per ACLS protocols if unstable or symptomatic)

• AF (10–16% incidence): βB or amio, ± digoxin (particularly if HF), heparin

• VT/VF: lido or amio × 6–24 h, then reassess; ↑ βB as tol., replete K & Mg, r/o ischemia; VT <48 h post-MI does not worsen prognosis; >48 h, consider ICD (see below)

• Accelerated idioventricular rhythm (AIVR): slow ventricular rhythm (<120 bpm), often after reperfusion; typically asx, gradual onset/offset, and does not require treatment

• Backup transcutaneous or transvenous pacing if: 2° AVB type II; BBB + AVB

• Transvenous pacing if: 3° AVB; new BBB + 2° AVB type II; alternating LBBB/RBBB