I. General principles of emergency treatment of cardiac arrhythmia The occurrence and development of cardiac arrhythmia are affected by many factors. In the face of patients with arrhythmia, the first step is to make a clear diagnosis and carry out risk stratification, and decide on the immediate and long-term treatment plan according to the degree of risk. The management of arrhythmias needs to take into account the correction of the underlying disease and predisposing factors. The choice of acute phase management of arrhythmias should be centered on hemodynamic status. Acute-phase management emphasizes efficiency, with the goal of stabilizing hemodynamic status and improving symptoms by correcting or controlling the arrhythmia. 1, first identify the correction of hemodynamic disorders Arrhythmia arrhythmia acute phase control, should be hemodynamic state to determine the principles of treatment. Hemodynamic status instability includes: progressive hypotension, signs and symptoms of shock, acute heart failure, progressive ischemic chest pain, impaired consciousness and so on. When hemodynamic instability is not treated in time, it will continue to deteriorate and even endanger life. Ectopic tachyarrhythmias with unstable hemodynamic status should be terminated as early as possible with electrical cardioversion, and temporary pacing should be used as soon as possible for severe bradyarrhythmias. If the hemodynamics is relatively stable, the diagnosis and differential diagnosis can be made according to the characteristics of electrocardiogram, combined with history and physical examination, and the corresponding treatment measures can be chosen. Treatment of underlying diseases and triggers Underlying diseases and cardiac function status are closely related to the occurrence of arrhythmia. Malignant arrhythmia caused by severe heart failure and acute myocardial infarction can be controlled with the improvement of cardiac function or the reconstruction of blood flow. Therefore, the treatment of the underlying disease and the correction of the relevant etiology should not be neglected during the emergency treatment of arrhythmia. Acute management of the underlying disease should be based on the recommendations of the appropriate guidelines. Certain triggers can also lead directly to arrhythmias, such as hypokalemia, acid-base balance disorders, and hyperthyroidism, which can be controlled by correcting the trigger. Underlying disease and arrhythmia can be the cause and effect of each other, which one comes first in emergency treatment depends on what is the main contradiction. For example, ST-segment elevation acute myocardial infarction combined with persistent ventricular tachycardia can lead to hemodynamic deterioration, which is easy to aggravate myocardial ischemia and induce ventricular fibrillation, so ventricular tachycardia should be terminated in priority, and then hemodialysis should be carried out as soon as possible. If ST-segment elevation acute myocardial infarction is combined with ventricular tachycardia, hemodialysis should be prioritized to reduce the risk of malignant ventricular arrhythmia, and hemodialysis should not be delayed in order to treat ventricular tachycardia. Strategies for arrhythmia management vary depending on the underlying state of the heart. For example, for pharmacologic reversal of atrial fibrillation (AF), amiodarone should be used in patients with organic heart disease rather than propafenone. Patients without organic heart disease can use propafenone or ibutilide. 3.Measuring the Benefit-Risk Ratio Aggressive measures should be taken to control life-threatening arrhythmias and to pursue the effectiveness of antiarrhythmic therapy to save lives. For the management of non-life-threatening arrhythmias, more consideration needs to be given to the safety of therapeutic measures, and over-treatment may instead lead to new risks. 4. Management of the arrhythmia itself Termination of the arrhythmia: If the arrhythmia itself is causing severe hemodynamic disturbances, termination of the arrhythmia becomes a primary and immediate task. Some arrhythmias can cause intolerable symptoms and can also be terminated, such as supraventricular tachycardia (SVT) and symptomatic atrial fibrillation. Improvement of symptoms: Some arrhythmias are not easily terminated immediately, but a rapid ventricular rate can worsen the hemodynamic state or cause significant symptoms. Slowing the ventricular rate can stabilize the condition and relieve symptoms, such as rapid atrial fibrillation (AF) and atrial flutter (AF). Some new ventricular premature, atrial pre-systole (atrial premature) with obvious symptoms, can also be appropriate medication, relieve symptoms, but not excessive application of anti-arrhythmic drugs. 5, correctly handle the treatment of contradictions in arrhythmia emergency treatment often encountered treatment contradictions. Such as the usual bradycardia, the occurrence of rapid atrial fibrillation; arrhythmia attack blood pressure is low but need to use amiodarone. In this case, the principle of treatment is to first take into account the main aspects of the conflict, i.e., to deal with the aspect that is currently more harmful to the patient, while the other side needs to be well planned. When the condition does not allow antiarrhythmic drug treatment, it is necessary to take some other measures to control arrhythmia and reduce symptoms. Intravenous medication requires attention to method and enhanced monitoring Intravenous medication is generally used for acute arrhythmic episodes, or recovery from existing arrhythmias. Because of its rapid and powerful effect, it is necessary to pay attention to strengthen the monitoring when applying. 2, pay attention to take the necessary protective measures for elderly patients, especially weekday heart rate is slow, rapid arrhythmia duration and long, must be alert to the existence of sinus node dysfunction, and the sinus node is fast ectopic rhythm point inhibition time is too long, so the drug resumed the moment, it is likely to have a long time of sinus pause, or even secondary to the malignant ventricular arrhythmia, it must be ready to do a good job of temporary pacing. Therefore, temporary pacing must be prepared. 3, the load should be given to the full application of amiodarone resumption of atrial fibrillation, must be given to the full load in order to take effect. Generally speaking, the loading dose of amiodarone is 5~7mg/kg, such as the weight of 60kg patients should be given at least 300mg, such as 300mg is not resumed, you can add 150mg. it is best to use the microchestnut or infusion pumps to give the drug to ensure that in the required time of uniform speed input. 4, the use of drugs should be correct The same drug treatment of the same arrhythmia, the use of different may have very different results. For example, when applying adenosine or ATP to recover paroxysmal supraventricular tachycardia, it is necessary to use projectile injection to be effective, i.e., the drug is pushed into the fastest within 1-2 seconds, and then immediately pushed into the fastest with 5 ml of physiological saline, so as to have immediate effect, and more than one minute or so to recover. Moreover, the use of drugs should be individualized, for example, the previous use of ATP are 20mg (1) rapid intravenous push, the scientific use of the drug should be given in accordance with the body weight, 0.1-0.3mg/kg, an average of 0.2mg/kg (for the body weight of 60kg of the patient only 12mg can be), can significantly reduce the incidence of adverse reactions. 5, pay attention to monitoring adverse drug reactions After the use of drugs should be regularly monitored electrocardiogram, blood and urine routine, liver and kidney function and other indicators, if necessary, chest X-ray, dynamic electrocardiogram, echocardiography and other tests. It is very important to ask about symptoms, conduct detailed physical examination, and compare with baseline data during outpatient review, which can help early detection and timely treatment.