{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T07:20:37Z","timestamp":1772349637041,"version":"3.50.1"},"reference-count":146,"publisher":"Oxford University Press (OUP)","issue":"16","license":[{"start":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T00:00:00Z","timestamp":1684972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This article, the first in a 2-part review, aims to reinforce current literature on the pathophysiology of cardiac arrhythmias and various evidence-based treatment approaches and clinical considerations in the acute care setting. Part 1 of this series focuses on atrial arrhythmias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Summary<\/jats:title><jats:p>Arrhythmias are prevalent throughout the world and a common presenting condition in the emergency department (ED) setting. Atrial fibrillation (AF) is the most common arrhythmia worldwide and expected to increase in prevalence. Treatment approaches have evolved over time with advances in catheter-directed ablation. Based on historic trials, heart rate control has been the long-standing accepted outpatient treatment modality for AF, but the use of antiarrhythmics is often still indicated for AF in the acute setting, and ED pharmacists should be prepared and poised to help in AF management. Other atrial arrhythmias include atrial flutter (AFL), atrioventricular nodal reentry tachycardia (AVNRT), and atrioventricular reentrant tachycardia (AVRT), which warrant distinction due to their unique pathophysiology and because each requires a different approach to utilization of antiarrhythmics. Atrial arrhythmias are typically associated with greater hemodynamic stability than ventricular arrhythmias but still require nuanced management according to patient subset and risk factors. Since antiarrhythmics can also be proarrhythmic, they may destabilize the patient due to adverse effects, many of which are the focus of black-box label warnings that can be overreaching and limit treatment options. Electrical cardioversion for atrial arrhythmias is generally successful and, depending on the setting and\/or hemodynamics, often indicated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Atrial arrhythmias arise from a variety of mechanisms, and appropriate treatment depends on various factors. A firm understanding of physiological and pharmacological concepts serves as a foundation for exploring evidence supporting agents, indications, and adverse effects in order to provide appropriate care for patients.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ajhp\/zxad108","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T14:04:58Z","timestamp":1685023498000},"page":"1039-1055","source":"Crossref","is-referenced-by-count":4,"title":["Pathophysiology and treatment of adults with arrhythmias in the emergency department, part 1: Atrial arrhythmias"],"prefix":"10.1093","volume":"80","author":[{"given":"Lance","family":"Ray","sequence":"first","affiliation":[{"name":"Denver Health and Hospital Authority , Denver, CO"},{"name":"Department of Emergency Medicine, University of Colorado , Aurora, CO , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Curtis","family":"Geier","sequence":"additional","affiliation":[{"name":"San Francisco General Hospital , San Francisco, CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle M","family":"DeWitt","sequence":"additional","affiliation":[{"name":"University of Vermont Medical Center , Burlington, VT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,5,25]]},"reference":[{"issue":"9","key":"2023080410525217200_CIT0001","doi-asserted-by":"crossref","first-page":"e007944","DOI":"10.1161\/CIRCEP.119.007944","article-title":"Procedural patterns and safety of atrial fibrillation ablation: findings from Get With The Guidelines-Atrial Fibrillation","volume":"13","author":"Loring","year":"2020","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2023080410525217200_CIT0002","article-title":"Top 200 drugs by retail sales in 2000","year":"2001","journal-title":"Drug Topics"},{"key":"2023080410525217200_CIT0003","author":"ClinCalc LLC"},{"issue":"2","key":"2023080410525217200_CIT0004","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1002\/clc.23778","article-title":"Efficacy and safety of same-day discharge after atrial fibrillation ablation: a systematic review and meta-analysis","volume":"45","author":"Rashedi","year":"2022","journal-title":"Clin Cardiol"},{"issue":"3","key":"2023080410525217200_CIT0005","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1038\/s41569-020-00451-x","article-title":"Catheter ablation for atrial fibrillation: current indications and evolving technologies","volume":"18","author":"Parameswaran","year":"2021","journal-title":"Nat Rev Cardiol"},{"issue":"10","key":"2023080410525217200_CIT0006","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1016\/j.ajem.2018.01.056","article-title":"Clinical pharmacy services in the emergency department","volume":"36","author":"Morgan","year":"2018","journal-title":"Am J Emerg Med"},{"key":"2023080410525217200_CIT0007","doi-asserted-by":"crossref","DOI":"10.1093\/ajhp\/zxab070","article-title":"Basic surface electrocardiogram interpretation for the pharmacist","author":"Mar","year":"2021","journal-title":"Am J Health-Syst Pharm"},{"key":"2023080410525217200_CIT0008","author":"World Health Organization"},{"issue":"8","key":"2023080410525217200_CIT0009","doi-asserted-by":"crossref","first-page":"e153","DOI":"10.1161\/CIR.0000000000001052","article-title":"Heart disease and stroke statistics\u20142022 update: a report from the American Heart Association","volume":"145","author":"Tsao","year":"2022","journal-title":"Circulation"},{"issue":"2","key":"2023080410525217200_CIT0010","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1177\/1747493019897870","article-title":"Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge","volume":"16","author":"Lippi","year":"2021","journal-title":"Int J Stroke"},{"issue":"13","key":"2023080410525217200_CIT0011","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1001\/archinte.1994.00420130036007","article-title":"Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. 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