Sudden onset of tachyarrhythmias in an operating theatre or an intensive care unit can be a frustrating experience for an attending physician and sometimes even for his patient, not only because of severity of patient’s clinical state, but also for the mental stress loaded on him by collaborating surgeons. From that reason, a diagnosis and treatment of such condition should be intensive, simple, effective and safe for the patient. Increased activity of sympathoadrenal system is the main pathophysiological condition in the pathogenesis of perioperative arrhythmias that can provoke sinus tachycardia followed with a transient myocardial ischaemia and other deleterious effects. Sympathetic nervous system stability plays an important role in the prevention and treatment of perioperative arrhythmias. In this review article, the author highlights a basic electrophysiology and molecular pathophysiology of heart rhythm disturbances, and on the background of recent clinical studies he tries to propose a simplified therapeutic algorithm for treatment of these difficult states. Beta-blockers and group III. antiarrhythmics of Vaughan-Williams classification (amidarone) are recommended as the optimal remedies for the treatment of tachyarrhythmias in the perioperative period.

        Key words: amidarone, beta-blockers, dofetilide, ibutilide, clonidine, antiarrhytmic classifications, Sicilian Gambit, pathophysiology, arrhythmogenesis, antiarrhythmics, proarrhythmias, perioperative arrhythmias.