Stratégie d'utilisation des antiarythmiques en phase préhospitalière et aux urgences

Antiarrhythmic agents (AAA) efficacy and side effects are not similar between molecules and pharmalogical classes. Prehospital and in hospital prescription of AAA should be very cautious as benefice/risk ratio of these molecules is low. The use of AAA in urgent situations should respond to the following priorities: evaluate the hemodynamic status of the patient, diagnose arrhythmia and underlying factors, respect AAA contraindications. Adenosine triphosphate is one of the most efficient treatment of nodo-ventricular re-entrant tachycardia; sotalol and amiodarone are efficient to treat ventricular tachycardia. The association of AAA is dangerous and should be avoided. Cardioversion is used in unstable hemodynamic status or failure of intraveinous drugs. During a prehospital and in hospital unstable arrhythmia, respecting AAA prescription rules prevents harmful side effects and helps to overcome critical situations in order to transfer the patient to a Cardiology Care Unit for further investigations and adequate long term treatment.