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Author: Admin | 2025-04-28
And require immediate life-saving treatment. Severe tachyarrhythmias Sustained ventricular tachycardia requires acute antiarrhythmic therapy and hospitalization. Lidocaine is the drug of choice (2-4 mg/kg IV, repeated to 6 mg/kg total cumulative dose followed by CRI 40-80 mcg/kg/min). Intravenous procainamide, esmolol, or amiodarone are other choices for refractory ventricular arrhythmias. Potassium levels should be assessed, as hypokalemia lessens the efficacy of lidocaine and should be corrected. Once the arrhythmia is stabilized, an echocardiogram should be done to assess whether there is severe myocardial failure, pericardial effusion and tamponade, or a cardiac mass. Identification of severe myocardial failure aids choice of the most appropriate chronic antiarrhythmic drug, since dogs with severe dilated cardiomyopathy cannot tolerate beta blockade. In these patients, choices are limited to mexilitene (5-7 mg/kg PO BID), flecainide (5 mg/kg PO TID), or amiodarone (10 mg/kg PO BID x 7 days then 5 mg/kg PO q24 hr), or very slow up-titration of sotalol. In dogs with normal systolic function, my first choice for antiarrhythmic drug is sotalol, and other choices include atenolol or the previously mentioned antiarrhythmic drugs. Sotalol or the combination of atenolol and mexilitene effectively decreases the severity of arrhythmia and reduces syncopal episodes in Boxer dogs with arrhythmogenic right ventricular cardiomyopathy.(5) Follow-up ECG and ideally holter monitoring is important after starting antiarrhythmic medication for continued chronic management. Often combination antiarrhythmic therapy is needed, such as sotalol and mexilitene, or amiodarone and low dose atenolol or mexilitene. Terminal arrhythmias include asystole, where there is lack of any electrical
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