World scientific research journal
https://scientific-jl.com/wsrj
Volume-40_Issue-1_June-2025
132
TACHYARRHYTHMIAS AND WAYS TO RESOLVING THEM
Ergashov Bobir Bakhodirovich
Bukhara State Medical Institute
e-mail:ergashov.bobir@bsmi.uz
Annotation.
Tachyarrhythmias are a group of heart rhythm disorders
characterized by rapid heartbeat (HR over 100 bpm). They can be of both
supraventricular and ventricular origin, ranging from benign to life-threatening forms.
This article discusses the main types of tachyarrhythmias, their pathophysiology,
clinical manifestations, diagnostic methods, as well as modern approaches to drug and
interventional therapy.
Keywors:
tachyarrhythmia,
supraventricular
tachycardia,
ventricular
tachycardia, ablation, antiarrhythmics, heart rate.
Introduction.
Tachyarrhythmias are a form of arrhythmia in which the heart rate
is abnormally high. These disorders can be episodic or constant, symptomatic or
asymptomatic, and have varying degrees of life-threatening effects. Their timely
diagnosis and correct treatment are critically important, especially in structural heart
diseases. With the development of cardiology, new effective methods for monitoring
and eliminating tachyarrhythmias have emerged, including radiofrequency ablation,
modern antiarrhythmic drugs, and devices such as implantable cardioverter-
defibrillators (ICDs).
Classification of tachyarrhythmias
Supraventricular tachyarrhythmias (SVT)
Sinus tachycardia
Physiological response to stress, anemia, thyrotoxicosis, etc.
Paroxysmal supraventricular tachycardia (PSVT)
Occurs as a result of re-entry mechanisms (eg, AV nodal reciprocating
tachycardia)
Atrial fibrillation
Ordered atrial activity with heart rate ~250–350/min
Atrial fibrillation (AF)
Chaotic electrical activity of the atria (discussed separately in other works)
Ventricular tachyarrhythmias
Ventricular tachycardia (VT)
Potentially life-threatening condition, especially in coronary artery disease,
cardiomyopathy
Ventricular fibrillation (VF)
The cause of most sudden cardiac deaths
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Polymorphic ventricular tachycardia (including torsades de pointes)
Associated with prolongation of the QT interval
Pathophysiology of tachyarrhythmias
Basic mechanisms:
1.
Increased automatism -
for example, with sinus tachycardia
2.
Trigger activity -
postdepolarizations, especially with prolonged QT
3.
Re-entry
(repeated entry of the excitation wave) is the most common
mechanism of SVT and VT
Predisposing factors:
Electrolyte disturbances
Myocardial ischemia
Structural changes (hypertrophy, fibrosis)
Genetic syndromes (Brugada, long QT)
Diagnostics
Diagnosis of tachyarrhythmia includes:
ECG
(at rest, under load, daily monitoring)
EFS (electrophysiological study) -
invasive rhythm mapping
Laboratory tests -
to exclude metabolic causes
Echocardiography -
to assess structural abnormalities
Cardiac MRI -
if myocarditis or cardiomyopathy is suspected
Clinical manifestations
Symptoms depend on the type of tachyarrhythmia and the presence of
concomitant diseases:
Heartbeat
Dyspnea
Chest pain
Fainting
Dizziness
In severe cases, cardiac arrest
Approaches to the treatment of tachyarrhythmias
Non-drug assistance
Treatment of PSVT:
Valsalva maneuver, carotid sinus massage
Cardioversion:
for hemodynamic instability or VF
Defibrillation:
for VF, unstable polymorphic VT
Drug therapy
Antiarrhythmic drugs
Class I -
sodium channel blockers (propafenone, flecainide)
Class II -
β-blockers (metoprolol, bisoprolol)
Class III -
potassium channel blockers (amiodarone, sotalol)
Class IV - calcium channel blockers (verapamil, diltiazem)
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The choice depends on the type of arrhythmia, the presence of coronary artery
disease, LV function and concomitant conditions.
Additional funds:
Magnesium -
for torsades de pointes
Anticoagulants -
for atrial fibrillation/flutter
Correction of electrolytes - potassium, magnesium
Invasive treatment methods
Catheter ablation
Indications
: refractory PSVT, atrial flutter, VT in ICM
High efficiency (up to 95% with PSVT)
Methods: radiofrequency, cryoablation
Implantable devices
ICD -
in case of previous VF or VT with high risk
CRT (cardiac resynchronization therapy)
- for CHF and blocks with AF/VT
Portable rhythm recorders -
for seizure diagnosis
Specific syndromes and their therapy
WPW (Wolff-Parkinson-White) syndrome
The reason is the additional path (Kent's bundle)
Risk: atrioventricular tachycardia, AF with transition to the ventricles
Treatment: Ablation of the accessory pathway
Long QT syndrome
Hereditary or drug-induced
Risk of torsades de pointes
Treatment: beta blockers, QT correction, ICD for high risk
Brugada syndrome
Congenital disorder with high risk of VF
Diagnosis: specific changes on ECG
Treatment: ICD, avoidance of triggers
Prevention and rehabilitation
Correction of arterial pressure, CHF, ischemic heart disease
Treatment of the underlying disease
Elimination of provoking factors: alcohol, stimulants, stress
Continuous monitoring and correction of therapy
Patient-centered education
Conclusion.
Tachyarrhythmias are a diverse and clinically significant group of
rhythm disorders that require a differentiated approach. Modern cardiology has a wide
range of tools for diagnosing and treating these conditions: from drug correction to
high-tech ablation procedures and device implantation. Successful treatment depends
on accurate classification of arrhythmia, risk assessment and individual selection of a
strategy.
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