Atrial Arrhythmias : Atlial fibrillation is the most common rhythm abnormality after CABG. Paroxysmal atrial tachycardia and atrial flutter are less common. Increased sympathetic stimulation and withdrawal of beta-blockers may be causative factors. The treatment is based on two principles: (1) Rate Control, and (2) Rhythm Control. Rapid intra venous digitalization is seldom used these days. If haemo dynamics is stable, beta-blockers are used intravenously with caution. Propranolol 0 .5 mg LV every two minutes up to a maximum dose of 4mg will help in most cases. Verapamil 40mg through naso gastric tube or up to 5mg IV are considered dangerous to treat AF. The currently favoured drug is amiodarone in doses of 5mgIkg given over 20 minutes as an infusion followed by continuous infusion for 4-8 hrs. Oral anliodarone therapy is then continued.
Atrial flutter and paroxysmal atrial tachycardia (PAT) can be controlled by rapid atrial pacing. Most of the inotropic agents make these arrhythmias worse. It is preferable to give these patients amrinone, which is an inodilator. Beta-blockers and Verapamil are also helpful. Heart block is treated by pacing through epicedial wires inserted at the time of operation or urgent transvenous temporary pacing.