Acute arrhythmias can occur at any age, at all levels of hospital and in all clinical departments. Failure to make correct judgments quickly and give timely treatment can lead to rapid hemodynamic deterioration and endanger life. Clinicians should be familiar with the emergency resuscitation process, standardize the application of antiarrhythmic drugs, and especially need to follow 7 major treatment principles: 1. Identify and correct hemodynamic disorders In the acute phase of arrhythmias, the treatment principles should first be decided according to hemodynamics. Hemodynamic instability, if not treated in a timely manner, the condition continues to progress and can be life-threatening in severe cases. At this time, the perfect diagnostic process should not be demanded, but the efficiency of rescue treatment should be pursued so as not to miss the time for rescue. Ectopic tachyarrhythmias with unstable hemodynamics should be terminated by electrical cardioversion as soon as possible, and severe slow arrhythmias should be treated by temporary pacing as soon as possible. For those with relatively stable hemodynamics, diagnosis and differential diagnosis can be made based on ECG characteristics, clinical symptoms, combined with medical history and physical examination, and appropriate therapeutic strategies can be selected, with the selected drugs being safety-oriented and not aggravating or complicating the condition. 2. Pay attention to the treatment of underlying diseases and causes Whether the arrhythmia is combined with organic heart disease directly determines the treatment strategy and affects the prognosis, which is a factor that cannot be ignored. In the emergency treatment of arrhythmia, the treatment of underlying diseases and the correction of related causes, especially myocardial ischemia and cardiac insufficiency, should not be neglected. The acute management of the underlying disease should be performed according to the recommendations of the appropriate guidelines. Underlying diseases and arrhythmias can be causally related, and the priority of emergency treatment depends on what is the main conflict. If the arrhythmia is the most urgent, the arrhythmia should be treated first. If the arrhythmia is secondary to an acute myocardial infarction, only premature ventricular contractions are manifested and are not life-threatening, the acute infarction can be treated first. 3.Measuring the benefit-risk ratio For life-threatening arrhythmias, active and effective measures should be taken to control and save lives. For the management of non-life-threatening arrhythmias, more consideration should be given to the safety of the treatment measures to avoid new risks caused by overtreatment. It should also be noted that the risk-to-benefit ratio can change with changes in the condition, and treatment measures should be flexibly adjusted. 4. Treatment of the arrhythmia itself If the arrhythmia itself causes severe hemodynamic disturbance, termination of the arrhythmia should be the first priority of treatment. For example, supraventricular tachycardia and symptomatic atrial fibrillation, which lead to intolerable symptoms in patients, should be promptly terminated. And certain arrhythmias (such as newly emerged atrial fibrillation, ventricular premature, atrial premature) do not necessarily need to be terminated immediately, but can be appropriately medicated first to relieve the symptoms. 5, correct treatment contradiction In the emergency treatment of arrhythmia often encounter treatment contradiction, such as the usual bradycardia, sudden occurrence of rapid atrial fibrillation; arrhythmia attack with low blood pressure need to use amiodarone. In this case, the main aspect of the contradiction (i.e., the current cause of the patient’s greater risk) should be measured and priority should be given to the main contradiction. If atrial fibrillation is combined with heart failure and bradycardia occurs during treatment, but there is no serious hemodynamic disorder, the bradycardia can be ignored for the time being. 6, taking into account the treatment and prevention (1) arrhythmias are prone to recurrence, and preventive measures should be taken to reduce recurrence after correction. The basic preventive measures include strengthening the treatment of the underlying disease, controlling the triggering factors, and determining whether to use antiarrhythmic drugs in conjunction with the patient’s condition. Not all arrhythmias need to be treated clinically; for example, immediate administration of antiarrhythmic drugs for long-term prophylaxis is not advocated for patients with a first episode of atrial fibrillation. (2) Drug therapy is generally required after termination of malignant ventricular arrhythmias to prevent recurrence. (3) After emergency treatment, the long-term treatment of arrhythmias should be considered and recommended. 7. Combined use of antiarrhythmic drugs Only one antiarrhythmic drug is generally used before electrical resuscitation, and sequential use is not advocated, and combined use is not advocated to avoid adverse drug interactions and proarrhythmic effects. If the efficacy of an intravenous antiarrhythmic drug is unsatisfactory, the standardization of the drug and the adequacy of the dose should be reviewed first. Short-term replacement or combination of another intravenous antiarrhythmic drug is not recommended, and non-pharmacologic methods such as electrical cardioversion or esophageal pacing should be considered. Only recalcitrant, recurrent malignant arrhythmias should be considered in combination.