Complications during vascular surgery: basic principles and management of arrhythmias

This chapter focuses on the anatomy and physiology of arrhythmias and specifically only on supraventricular arrhythmias, as these are the most common requiring treatment in the perioperative period. Rational treatment of arrhythmias requires an understanding of the anatomy of the conduction system, the pathophysiological and electrophysiological basis of arrhythmias, and the basic mechanisms of anti-arrhythmic drug action. This chapter reviews the basic anatomy of the conduction system and then focuses on both abnormal impulse generation and conduction. The conventional classification of anti-arrhythmic drugs is then discussed, followed by some newer approaches to classification based on a more detailed understanding of the mechanisms of action. Finally, management of common supraventricular arrhythmias is presented.