[Emergency pharmacotherapy in rhythmology].

Acute cardiac arrhythmias are among the most common and prognostically relevant emergency situations in clinical cardiac electrophysiology. They range from bradycardia and supraventricular tachycardia to atrial fibrillation and atrial flutter to potentially life-threatening ventricular tachyarrhythmias and electrical storm. In these situations, rapid, structured and guideline-based pharmacotherapy is essential to prevent hemodynamic instability and mortality.The selection of appropriate emergency medication depends primarily on the underlying arrhythmia, the hemodynamic situation and individual patient factors such as structural heart disease, heart failure and comorbidities. In addition to classical antiarrhythmic drugs, substances that act on the atrioventricular (AV) node, beta blockers, calcium channel blockers, adenosine, glycosides and catecholamines also play a central role in acute treatment.As no new antiarrhythmic drugs have been approved for clinical practice in the past 15 years, established substances continue to be of particular importance. In addition, antiarrhythmic drugs that are not regularly available in Germany, such as procainamide or mexiletine, are also being discussed, as they may be prognostically relevant, particularly in complex bail-out situations involving ventricular arrhythmias.