What is the treatment for Premature Atrial Contractions (PACs) on an electrocardiogram (EKG)?

From the Guidelines

For patients with paroxysmal atrial tachycardia (PAT) on an EKG, the most effective treatment is adenosine (6mg IV rapid push, followed by 12mg if needed) due to its ultra-short half-life and effectiveness in terminating the arrhythmia, as supported by the 2009 ACCF/AHA guidelines 1. When treating PATs, it's essential to consider the patient's hemodynamic stability and underlying causes.

• For stable patients, vagal maneuvers like carotid sinus massage or Valsalva can be attempted first.
• If unsuccessful, adenosine is the first-line medication, as it has been shown to be effective in terminating the arrhythmia.
• Beta-blockers like metoprolol or calcium channel blockers like diltiazem can be used if adenosine fails, as they have been shown to accelerate the conversion of postoperative supraventricular arrhythmias to sinus rhythm compared with diltiazem 1.
• For unstable patients with hypotension or altered mental status, synchronized cardioversion starting at 50-100J is recommended. The 2009 ACCF/AHA guidelines suggest that beta-blocker therapy can reduce the incidence of arrhythmias during the perioperative period 1, which is relevant for patients with PATs.
• Long-term management may include daily medications such as beta-blockers, calcium channel blockers, or antiarrhythmics like flecainide or propafenone, with catheter ablation as a definitive treatment option for recurrent episodes. It's crucial to note that PATs typically originate from an ectopic atrial focus with enhanced automaticity or triggered activity, creating a reentrant circuit that bypasses the normal conduction pathway, and treatment should be tailored to the individual patient's needs and underlying conditions, as outlined in the 2009 ACCF/AHA guidelines 1.

From the Research

Treatment Options for Paroxysmal Supraventricular Tachycardia (PSVT)

• First-line acute therapy for hemodynamically stable patients includes:
  • Vagal maneuvers such as the modified Valsalva maneuver, which is 43% effective 2
  • Intravenous adenosine, which is 91% effective 2
• For patients who are hemodynamically unstable, emergent cardioversion is recommended 2
• Catheter ablation is a safe and highly effective therapy to prevent recurrence of PSVT, with single procedure success rates of 94.3% to 98.5% 2
• Pharmacotherapy, including calcium channel blockers, β-blockers, and antiarrhythmic agents, is also an important component of acute and long-term management of PSVT 2

Diagnosis of PSVT on EKG

• Diagnosis is made on electrocardiogram during an arrhythmic event or using ambulatory monitoring 2
• EKG can show tachyarrhythmias that originate from or conduct through the atria or atrioventricular node with abrupt onset, which is characteristic of PSVT 2