19. Antiarrhythmic Drugs

  1. David H. Bennett MD FRCP

Published Online: 1 NOV 2012

DOI: 10.1002/9781118432389.ch19

Bennett's Cardiac Arrhythmias: Practical Notes on Interpretation and Treatment, Eighth Edition

Bennett's Cardiac Arrhythmias: Practical Notes on Interpretation and Treatment, Eighth Edition

How to Cite

Bennett, D. H. (2013) Antiarrhythmic Drugs, in Bennett's Cardiac Arrhythmias: Practical Notes on Interpretation and Treatment, Eighth Edition, John Wiley & Sons, Ltd, Oxford. doi: 10.1002/9781118432389.ch19

Author Information

  1. Senior Consultant Cardiologist, University Hospital of South Manchester, Manchester, UK

Publication History

  1. Published Online: 1 NOV 2012
  2. Published Print: 14 JAN 2013

ISBN Information

Print ISBN: 9780470674932

Online ISBN: 9781118432389

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Keywords:

  • Adenosine and Amiodarone;
  • Antiarrhythmic drugs;
  • Digoxin and Diltiazem;
  • Disopyramide and Dofetilide;
  • Dronedarone and Flecainide;
  • Lignocaine;
  • Proarrhythmic effect;
  • Procainamide and Propafenone;
  • Quinidine;
  • Ranalozine and Sotalol;
  • Verapamil and Vernakalant

Summary

Antiarrhythmic drugs are of limited efficacy and often cause unwanted effects. They are better at terminating arrhythmias than at preventing their recurrence. Drugs can be proarrhythmic, particularly if ventricular function is impaired.

Flecainide is effective at preventing atrial fibrillation but is contraindicated in patients with poor ventricular function or coronary disease. Adenosine is the treatment of choice for termination of atrioventricular junctional re-entrant tachycardias. Intravenous verapamil will quickly control the ventricular response to atrial fibrillation and flutter. Sotalol may be effective in treating supraventricular and ventricular arrhythmias but caution is required because it prolongs the QT interval. Digoxin toxicity is common, and alternative antiarrhythmic drugs can be used in most situations. Amiodarone is the most effective agent currently available but because of its unwanted effects its use should be confined to patients with arrhythmias that are dangerous or are refractory to other forms of treatment.