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ARITMIA
FARMAKOTERAPI

Konduksi jantung dan elektrofisiologi

The heart functions via both mechanical and electrical activity

The mechanical activity of the heart refers to atrial and ventricular

contraction, the mechanism by which blood is delivered to tissues

Darah mengalir dari seluruh tubuh ---Kontraksi atrium kanan----

ventrikel kanan-- vena pulmonal ---- atrium kiri ---ventrikel kiri ---
jaringan tubuh

Katup-katup jantung: trikuspidus, pulmonary, mitral

Aktivitas mekanik jantung (kontraksi atrium dan ventrikel) dihasilkan dari

aktivitas listrik jantung.

The heart possesses an intrinsic electrical conduction system

Malfunction of the hearts electrical conduction system may result in

dysfunctional atrial and/or ventricular contraction

Under normal circumstances, the sinoatrial (SA) node (also known as the sinus
node), located in the upper portion of the right atrium, serves as the
pacemaker of the heart and generates the electrical impulses that
subsequently result in atrial and ventricular depolarization.The SA node serves
as the hearts pacemaker because it has the greatest degree of automaticity,
which is defined as the ability of a cardiac fiber or tissue to initiate
depolarizations spontaneously. In adults at rest, the normal intrinsic
depolarization rate of the SA node is 60 to 100 per minute. Other cardiac fibers
also possess the property of automaticity, but normally the intrinsic
depolarization rates are slower than that of the SA node.

Elektrokardiogram (EKG)

Phase 0 of the action potential corresponds to the QRS complex;

therefore, the QRS complex on the ECG is a non-invasive representation of
ventricular depolarization.

The T wave on the ECG corresponds to phase 3 repolarization of the

ventricles.

The interval from the beginning of the Q wave to the end of the T wave,
known as the QT interval, is used as a non-invasive marker of ventricular
repolarization time.

Potensial aksi ventrikel

Mechanisms of Cardiac Arrhythmias

In general, cardiac arrhythmias are caused by (1) abnormal impulse

formation; (2) abnormal impulse conduction; or (3) both.

Aritmia jantung (cardiac arrhythmias)

In general, cardiac arrhythmias are classified into two broad categories:

supraventricular (those occurring above the ventricles)

Sinus bradikardia: Sinus bradycardia is an arrhythmia that originates in the SA node, defined
by a sinus rate less than 60 beats per minute (bpm).

AV nodal blockade: occurs when conduction of electrical impulses through the AV node is
impaired to varying degrees

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice.

and ventricular (those occurring in the ventricles)

Ventricular Premature Depolarizations

Ventricular Tachycardia

Ventricular Fibrillation

Torsades de Pointes (perpanjangan QT interval pada EKG)

Manifestasi klinik

dizziness, fatigue, lightheadedness, syncope, chest pain (in patients with

underlying myocardial ischemia), and shortness of breath and other
symptoms of heart failure (in patients with underlying left ventricular
dysfunction).

Atrial Fibrillation

Atrial fibrillation (AF) is the most common arrhythmia encountered in

clinical practice.

It is important for clinicians to understand AF, because

it is associated with substantial morbidity and mortality and because many

strategies for drug therapy are available.

Drugs used to treat AF often have a narrow therapeutic index and a broad
adverse effect profile

Epidemiology

Approximately 2.3 million Americans have AF.

The prevalence of AF increases with advancing age; roughly 9% of

patients between the ages of 80 and 89 years have AF.

Similarly, the incidence of AF increases with age, and it occurs more

commonly in men than women

Etiology

The common feature of the majority of etiologies of AF is the development of

left atrial hypertrophy.

Hypertension may be the most important risk factor for development of AF.

However, AF occurs commonly in patients with CAD.

In addition, HF is increasingly recognized as a cause of AF; approximately 25%

to 30% of patients with New York Heart Association (NYHA) class III heart failure
have AF and the arrhythmia is present in as many as 50% of patients with NYHA
class IV heart failure

Drug-induced AF is relatively uncommon, and the list of drugs that may induce
AF is relatively small. However, acute ingestion of large amounts of alcohol
may cause AF; this phenomenon has been referred to as the holiday heart
syndrome

Etiologi AF

Patofisiologi

Atrial fibrillation may be caused by both abnormal impulse formation and

abnormal impulse conduction

AF was believed to be initiated by premature impulses initiated in the atria.

However, it is now understood that in many patients AF is triggered by

electrical impulses generated within the pulmonary veins (increased
automaticity)

The AV node is incapable of conducting 350 to 600 impulses per minute;

however, it may conduct 100 to 200 impulses per minute, resulting in
ventricular rates ranging from 100 to 200 bpm

Klasifikasi AF

Resiko stroke iskemia

Atrial fibrillation is associated with substantial morbidity and mortality. Atrial fibrillation is
associated with a risk of ischemic stroke of approximately 5% per year.

The risk of stroke is increased two- to seven-fold in patients with AF compared to patients
without this arrhythmia.

Atrial fibrillation is the cause of roughly one of every six strokes.

During AF, atrial contraction is absent. Therefore, due to the fact that atrial contraction is
responsible for approximately 30% of left ventricular filling, this blood that is not ejected
from the left atrium to the left ventricle pools in the atrium, particularly in the left atrial
appendage.

Blood pooling facilitates the formation of a thrombus, which subsequently may travel
through the mitral valve into the left ventricle and may be ejected during ventricular
contraction. The thrombus then may travel through a carotid artery into the brain,
resulting in an ischemic stroke.

Manifestasi klinik

Klasifikasi obat aritmia

due to differences in the potency of the drugs to slow conduction velocity,

the class I drugs are subdivided into class IA, IB, and IC.

The class IC drugs have the greatest potency for slowing ventricular
conduction, the class IA drugs have intermediate potency, and the class
IB drugs have the lowest potency, with minimal effects on conduction
velocity.

Class II drugs are the adrenergic -receptor inhibitors (-blockers),

class III drugs are those that inhibit ventricular repolarization or prolong
refractoriness, and

class IV drugs are the calcium channel blockers (CCBs), diltiazem and
verapamil.

algoritma
AF dgn
obat
intravena

Algoritma
AF dgn
obat oral

Algoritma pencegahan stroke pada

AF