Premature atrial contractions

  • Usually idiopathic and benign
  • May be due to catecholamine excess, electrolyte abnormalities, lines, hypoxia, or acid base disturbances
  • Generally no treatment is needed
  • Should correct lytes if abnormal and evaluate lineplacement
  • Typically resolve w/ time

Premature ventricular contractions

  • More worrisome than PACs
  • Seen w/ electrolyte abnormalities, hypoxia, hypocalcemia, catecholamine excess
  • Monitor how frequent, number in a row, unifocal or multifocal
  • Treatment depends on frequency, rate, associated conditions, and if a structural or functional change
  • Always correct lytes and evaluate line placement


  • If asymptomatic, usually no treatment
  • Acute treatment: Atropine, isoproterenol, or temporary pacing
  • Chronic treatment: Pacing

Heart block

  • 1° heart block in absence of heart disease usually does not progress
  • Watch 2° heart block closely as may develop into worsening heart block
  • Avoid meds which slow AV conduction (β blockers Ca Channel blockers, Dig)
  • Tx as above for bradycardia

Supraventricular tachycardia

  • Follow PALS guidelines!
  • If adequate perfusion
    • Vagal maneuvers (ice to face, knees to chest) 
    • Adenosine
      • Give 0.1 mg/kg IV/IO (max first dose 6mg) May double and repeat second dose (max 12 mg)
      • Give as rapid bolus followed by flush Try to use central line or IV closest to heart
    • Consult cardiology
      • Consider antiarrhythmic meds
      • esmolol, amiodarone or procainamide
      • Consider overdrive pacing
    • Cardioversion
      • Use 0.5 to 1 J/kg, may increase to 2 J/kg if initial dose is ineffective
      • Use sedation if possible (Etomidate 0.1mg/kg is a good choice, may repeat dose as needed)
  • If inadequate perfusion
    • 1) IMMEDIATE Cardioversion
      • Use 0.5-1 J/kg, may increase to 2 J/kg if needed
      • Do not delay cardioversion for sedation

Junctional ectopic tachycardia (post-operative)

  • Correct acidosis and electrolyte abnormalities (Mg, K, Ca)
  • Mild hypothermia (35 degrees Celsius)
  • Reduce inotropic agents (NE, Epi) as able
  • Make sure adequate pain control (sedation)
  • Consult cardiology
  • Slower rates may not need treatment (<170 bpm)
  • For higher rates, consider atrial overdrive pacing (higher rates may gain AV synchrony thus causing improved filling)
  • Consider antiarrhythmic medications (amiodarone, procainamide)
  • Chronic treatment: Pacing