Junctional Rhythm Medication

Author: Sean C Beinart, MD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD more...

Updated: Dec 15, 2010

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Medication Summary
Anticholinergics
Antidigitalis agents
Antiarrhythmic agents, Class 1-B
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References

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Class Summary

Agents used to accelerate heart rate if symptomatic bradycardia is present.

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Atropine IV/IM

Used to increase heart rate through vagolytic effects, causing an increase in cardiac output.

Class Summary

Used to treat digitalis toxicity.

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Digoxin immune Fab (Digibind)

Immunoglobulin fragment with a specific and high affinity for both digoxin and digitoxin molecules. Removes digoxin or digitoxin molecules from tissue binding sites.

Each vial of Digibind contains 40 mg of purified digoxin-specific antibody fragments, which bind approximately 0.6 mg of digoxin or digitoxin. Dose of antibody depends on total body load (TBL) of digoxin; estimates of TBL can be made in 3 ways, as follows:

(1) Estimate quantity of digoxin ingested in acute ingestion and assume 80% bioavailability (amount ingested [mg] X 0.8 = TBL).

(2) Obtain a serum digoxin concentration and, using a pharmacokinetics formula, incorporate the Vd of digoxin and the patient's body weight in kg (TBL = digoxin serum level [ng/mL] X 6 L/kg X body weight in kg).

(3) Use an empiric dose based on average requirements for an acute or chronic overdose in an adult or child.

If the quantity of ingestion cannot be estimated reliably, administer empirically (safest to use the largest calculated estimate); alternatively, be prepared to increase dosing if resolution is incomplete.

Class Summary

These agents alter the electrophysiologic mechanisms responsible for arrhythmia.

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Phenytoin (Dilantin)

Depresses spontaneous depolarization in ventricular tissues.

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Contributor Information and Disclosures

Author

Sean C Beinart, MD, FACC, FHRS Electrophysiologist, Cardiac Associates, PC

Sean C Beinart, MD, FACC, FHRS is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Medical Association, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Alan D Forker, MD Professor of Medicine, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research, MidAmerica Heart Institute of St Luke's Hospital

Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hypertension, and Phi Beta Kappa

Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee with no personal profit; Speakers Bureau Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Steven J Compton, MD, FACC, FACP Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals

Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Amer Suleman, MD Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD Professor of Medicine and Pharmacology, Director, Clinical Cardiac Electrophysiology Fellowship Program, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)

Disclosure: Nothing to disclose.

References

Kim D, Shinohara T, Joung B, Maruyama M, Choi EK, On YK. Calcium dynamics and the mechanisms of atrioventricular junctional rhythm. J Am Coll Cardiol. Aug 31 2010;56(10):805-12. [Medline].
Deal BJ, Wolff GS, Gelband H. Current Concepts in Diagnosis and Management of Arrhythmias in Infants and Children. New York, NY: Futura Publishing; 1998:73-5.
Josephson ME. Clinical Cardiac Electrophysiology. 4^th ed. Baltimore, Md: Williams & Wilkins; 2008.
Libby P, Bonow RO, Mann DL, Zipes, DP. Specific arrhythmias: diagnosis and treatment. In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. 8^th ed. Philadelphia, Pa: WB Saunders; 2007:640-5.
Daubert JP, Rosero SZ, Corsello A. Tachycardias. In: Rakel RE, Bope ET, eds. Conn's Current Therapy. New York, NY: WB Saunders; 2001:286-95.