Chapter 22: Managing Arrhythmias & Conduction Problems

Managing Arrhythmias & Conduction Problems begins by reviewing the normal electrical conduction system of the heart, defining key physiologic concepts such as automaticity, excitability, conductivity, and contractility, while explaining the relationship between electrical depolarization and mechanical systole. The text details the systematic analysis of electrocardiogram (ECG) waveforms, guiding learners through the measurement of P waves, the QRS complex, and PR or QT intervals to determine heart rate and rhythm regularities. A significant portion of the chapter categorizes arrhythmias by their site of origin, including sinus node dysfunctions like sinus bradycardia and tachycardia, and atrial arrhythmias such as premature atrial complexes (PACs), atrial flutter, and atrial fibrillation, emphasizing the latter's association with thromboembolic risks and the need for antithrombotic therapy. It further explores junctional rhythms and life-threatening ventricular arrhythmias, specifically ventricular tachycardia and ventricular fibrillation, which require immediate emergency interventions like cardiopulmonary resuscitation (CPR) and defibrillation. The chapter also classifies atrioventricular (AV) conduction blocks into first-degree, second-degree (Type I and II), and third-degree blocks, identifying the clinical significance and treatment for each. Therapeutic modalities are extensively covered, distinguishing between synchronized electrical cardioversion for hemodynamically unstable tachycardias and unsynchronized defibrillation for pulseless events. Furthermore, the content outlines the indications and nursing management for invasive therapies, including catheter ablation, the Maze procedure, and the implantation of cardiac electronic devices such as permanent pacemakers and implantable cardioverter defibrillators (ICDs). Finally, the chapter integrates the nursing process to address patient care, focusing on maintaining cardiac output, reducing anxiety, preventing infection at device insertion sites, and providing comprehensive education on self-care and lifestyle modifications.