Approach to Assessment and Management of Arrhythmias

Classification and Diagnosis

The European Heart Journal recommends considering structural heart disease, such as ischemic heart disease or cardiomyopathies, as a potential cause of arrhythmias 2
The American Heart Association, as published in Circulation, suggests that ventricular arrhythmias, including premature ventricular contractions (PVCs) and non-sustained ventricular tachycardia (NSVT), can be associated with structural heart disease 1
Inherited arrhythmic syndromes, such as long QT syndrome and Brugada syndrome, should be considered in patients with a family history of sudden cardiac death or arrhythmias, according to the European Heart Journal 2
The European Heart Journal recommends evaluating patients with arrhythmias for metabolic and toxic causes, including electrolyte disturbances and drug-induced arrhythmias 2

A 12-lead ECG is essential for diagnosing arrhythmias, and the American Heart Association, as published in Circulation, recommends obtaining an ECG during tachycardia to determine the underlying rhythm 5
Ambulatory monitoring, including 24-hour Holter monitoring and event/loop recorders, can be used to diagnose arrhythmias, especially in patients with infrequent symptoms, according to the American Heart Association, as published in Circulation 1
Exercise testing can be used to evaluate patients with arrhythmias, especially those with symptoms during exertion, and the American Heart Association, as published in Circulation, recommends it as a Class I indication for patients with suspected ischemic heart disease or catecholaminergic polymorphic VT 5
Cardiac imaging, including echocardiography and cardiac MRI, can be used to evaluate cardiac structure and function in patients with arrhythmias, and the European Heart Journal recommends it for patients with suspected structural heart disease 7

The European Heart Journal recommends optimizing heart failure management and correcting electrolyte disturbances to reduce the risk of arrhythmias 2
Antiarrhythmic drugs, such as flecainide, can be used to treat arrhythmias, but the European Heart Journal recommends careful consideration of the risks and benefits, including the potential for proarrhythmic effects 2
The American Heart Association, as published in Circulation, recommends referral to a cardiologist for patients with arrhythmic syncope, structural heart disease, or QT prolongation 4

The European Heart Journal recommends evaluating patients with arrhythmias for risk factors, including family history, cardiac history, and medication use, to determine the underlying cause and guide management 2
The American Heart Association, as published in Circulation, suggests that patients with arrhythmias should be evaluated for proarrhythmic risk, including the potential for antiarrhythmic drugs to worsen arrhythmias 1