Skip to main content
SpringerLink
Log in

Anti-Arrhythmic Drugs

  • Chapter
  • First Online:
Clinical Handbook of Cardiac Electrophysiology

  • 1299 Accesses

Abstract

Anti-arrhythmic drugs (AAD’s) alter the electrical properties of the heart principally by either prolonging the cardiac action potential, decreasing conduction velocity, reducing focal automaticity or a combination of these effects. Despite the fact that a large number of AAD’s were initially developed for ventricular arrhythmias the most common current indication is currently atrial fibrillation (AF).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Alboni P, Botto GL, Baldi N, et al. Outpatient treatment of recent-onset atrial fibrillation with the “pill-in-the-pocket” approach. N Engl J Med. 2004;351:2384–91.

    Article  CAS  PubMed  Google Scholar 

  • Aliot E, Denjoy I. Comparison of the safety and efficacy of flecainide versus propafenone in hospital out-patients with symptomatic paroxysmal atrial fibrillation/flutter. The Flecainide AF French Study Group. Am J Cardiol. 1996;77:66A–71A.

    Article  CAS  PubMed  Google Scholar 

  • Alp NJ, Bell JA, Shahi M. Randomised double blind trial of oral versus intravenous flecainide for the cardioversion of acute atrial fibrillation. Heart. 2000;84:37–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Atkinson A, Ruo T. Pharmacokinetics of N-acetylprocainamide. Angiology. 1986;37:959–67.

    PubMed  Google Scholar 

  • Belhassen B, Glick A, Viskin S. Efficacy of quinidine in high-risk patients with Brugada syndrome. Circulation. 2004;110:1731–7.

    Article  PubMed  Google Scholar 

  • Brogan BL, Olsen NJ. Drug-induced rheumatic syndromes. Curr Opin Rheumatol. 2003;15:76.

    Article  PubMed  Google Scholar 

  • Calo L, Rebecchi M, Sette A, et al. Efficacy of ivabradine administration in patients affected by inappropriate sinus tachycardia. Heart Rhythm. 2010;7:1318–23.

    Article  PubMed  Google Scholar 

  • Camm AJ. Safety considerations in the pharmacological management of atrial fibrillation. Int J Cardiol. 2008;127:299–306.

    Article  PubMed  Google Scholar 

  • Campbell RW. Mexiletine. N Engl J Med. 1987;316:29–34.

    Article  CAS  PubMed  Google Scholar 

  • Chimienti M, Cullen MT, Casadei G. Safety of long-term flecainide and propafenone in the management of patients with symptomatic paroxysmal atrial fibrillation: report from the Flecainide and Propafenone Italian Study Investigators. Am J Cardiol. 1996;77:60A–75A.

    Article  CAS  PubMed  Google Scholar 

  • Connolly SJ, Dorian P, Roberts RS, et al. Comparison of β-blockers, amiodarone plus β-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the OPTIC study: a randomized trial. JAMA. 2006;295(2):165–71. https://doi.org/10.1001/jama.295.2.165.

    Article  CAS  PubMed  Google Scholar 

  • Connolly SJ, Crijns H, Torp-Pedersen C, et al. Analysis of stroke in ATHENA: a placebo-controlled, double-blind, parallel-arm trial to assess the efficacy of dronedarone 400 mg BID for the prevention of cardiovascular hospitalization or death from any cause in patients with atrial fibrillation/atrial flutter. Circulation. 2009;120:1174–80.

    Article  CAS  PubMed  Google Scholar 

  • Coplen SE, Antman EM, Berlin JA, et al. Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials. Circulation. 1990;82:1106–16.

    Article  CAS  PubMed  Google Scholar 

  • Davy JM, Herold M, Hoglund C, et al. Dronedarone for the control of ventricular rate in permanent atrial fibrillation: the Efficacy and safety of dRonedArone for the cOntrol of ventricular rate during atrial fibrillation (ERATO) study. Am Heart J. 2008;156:527–9.

    Article  PubMed  CAS  Google Scholar 

  • Di Francesco D, Camm JA. Heart rate lowering by specific and selective If current inhibition with ivabradine: a new therapeutic perspective in cardiovascular disease. Drugs. 2004;64:1757–65.

    Article  Google Scholar 

  • DiMarco JP, Sellers TD, Lerman BB, et al. Diagnostic and therapeutic use of adenosinein patients with supraventricular tachyarrhythmias. J Am Coll Cardiol. 1985;6:417–25.

    Article  CAS  PubMed  Google Scholar 

  • Dorian P, Cass D, Schwartz B, et al. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002;346:884–90.

    Article  CAS  PubMed  Google Scholar 

  • Ehrlich JR, Look C, Kostev K, et al. Impact of dronedarone on the risk of myocardial infarction and stroke in atrial fibrillation patients followed in general practices in Germany. Int J Cardiol. 2019;278:126–32.

    Article  PubMed  Google Scholar 

  • Elayi CS, Shohoudi A, Moodie E, et al. Digoxin, mortality, and cardiac hospitalizations in patients with atrial fibrillation and heart failure with reduced ejection fraction and atrial fibrillation: an AF-CHF analysis. Int J Cardiol. 2020;313:48–54.

    Article  PubMed  Google Scholar 

  • Fernández-Martinez, Marcos FJ, Garcia-Garmendia JL, et al. Comparison of intravenous flecainide, propafenone, and amiodarone for conversion of acute atrial fibrillation to sinus rhythm. Am J Cardiol. 2000;86:950–3.

    Article  Google Scholar 

  • Fetsch T, Bauer P, Engberding R, et al. Prevention of atrial fibrillation after cardioversion: results of the PAFAC trial. Eur Heart J. 2004;25:1385–94.

    Article  PubMed  Google Scholar 

  • Freemantle N, Cleland J, Young P, et al. Beta Blockade after myocardial infarction: systematic review and meta regression analysis. BMJ. 1999;318:1730–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Fuster V, Ryden LE, Cannom DS, et al. European Heart Rhythm Association, Heart Rhythm Society, ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol. 2006;48:854–906.

    Article  PubMed  Google Scholar 

  • Goldschlager N, Epstein AE, Naccarelli G, et al. Practical guidelines for clinicians who treat patients with amiodarone. Heart Rhythm. 2007;4:1250–9.

    Article  PubMed  Google Scholar 

  • Grace AA, Camm AJ. Quinidine. N Engl J Med. 1998;338:35–45.

    Article  CAS  PubMed  Google Scholar 

  • Hallstrom AP, Cobb LA, Yu BH, et al. An antiarrhythmic drug experience in 941 patients resuscitated from an initial cardiac arrest between 1970 and 1985. Am J Cardiol. 1991;68:1025–31.

    Article  CAS  PubMed  Google Scholar 

  • Herlitz J, Bang A, Holmberg M, et al. Rhythm changes during resuscitation from ventricular fibrillation inrelation to delay until defibrillation, number of shocks delivered andsurvival. Resuscitation. 1997;34:17–22.

    Article  CAS  PubMed  Google Scholar 

  • Hohnloser SH, Crijns H, Eickels M, et al. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med. 2009;360:668–78.

    Article  CAS  PubMed  Google Scholar 

  • Jusko W, Evans W, Schentag J. Applied pharmacokinetics: principles of therapeutic drug monitoring. San Francisco: Applied Therapeutics; 1980. p. 618–38.

    Google Scholar 

  • Karlson BW, Torstensson I, Abjorn C, et al. Disopyramide in the maintenance of sinus rhythm after electroconversion of atrial fibrillation. A placebo-controlled one-year follow-up study. Eur Heart J. 1988;3:284–90.

    Article  Google Scholar 

  • Katkov W, Ellrodt AG. Neutropenia and procainamide. Am Heart J. 1985;110:1321–2.

    Article  CAS  PubMed  Google Scholar 

  • Kober L, Torp-Pedersen C, McMurray JJ, et al. Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med. 2008;358:2678–87.

    Article  PubMed  Google Scholar 

  • Komura S, Chinushi M, Furushima H, et al. Efficacy of procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia. Circ J. 2010;74(5):43–6.

    Article  CAS  Google Scholar 

  • Kuck KH, Cappato R, Siebels J, Ruppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Hamburg (CASH). Circulation. 2000;102:748–54.

    Article  CAS  PubMed  Google Scholar 

  • Kuhlkamp V, Schirdewan A, Stangl K, et al. Use of metoprolol CR/XL to maintain sinus rhythm after conversion from persistent atrial fibrillation: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol. 2000;36:139–46.

    Article  CAS  PubMed  Google Scholar 

  • Lafuente-Lafuente C, Mouly S, Longas-Tejero MA, et al. Antiarrhythmic drugs for maintaining sinus rhythm after cardioversion of atrial fibrillation: a systematic review of randomized controlled trials. Arch Intern Med. 2006;166:719–28.

    Article  CAS  PubMed  Google Scholar 

  • Lehmann MH, Hardy S, Archibald D, et al. Sex difference in risk of torsade de pointes with d,l-sotalol. Circulation. 1996;94:2535–4251.

    Article  CAS  PubMed  Google Scholar 

  • Lerman BB, Belardinelli L. Cardiac electrophysiology of adenosine. Basic and clinical concepts. Circulation. 1991;83:1499–509.

    Article  CAS  PubMed  Google Scholar 

  • Lie KI, Wellens HJ, van Capelle FJ, Durrer D. Lidocaine in the prevention of primary ventricular fibrillation: a double-blind, randomized study of 212 consecutive patients. N Engl J Med. 1974;291:1324–6.

    Article  CAS  PubMed  Google Scholar 

  • MacMahon S, Collins R, Peto R, et al. Effects of prophylactic lidocaine in suspected acute myocardial infarction. An overview of results from the randomized, controlled trials. JAMA. 1988;260:1910–6.

    Article  CAS  PubMed  Google Scholar 

  • Markey GC, Salter N, Ryan J. Intravenous flecainide for emergency department management of acute atrial fibrillation. J Emerg Med. 2018;54:320–7.

    Article  PubMed  Google Scholar 

  • Mason JW. A comparison of seven antiarrhythmic drugs in patients with ventricular tachyarrhythmias. Electrophysiologic Study versus Electrocardiographic Monitoring Investigators. Engl J Med. 1993;329:452–8.

    Article  CAS  Google Scholar 

  • McAlister FA, Wiebe N, Ezekowitz JA, et al. Meta-analysis: beta-blocker dose, heart rate reduction, and death in patients with heart failure. Ann Intern Med. 2009;150:784–94.

    Article  PubMed  Google Scholar 

  • McCornish M, Robinson C, Kitson D, et al. Clinical electrophysiologic effects of mexiletine. Postgrad Med. 1977;33 (Suppl):85.

    Google Scholar 

  • McIntyre WF, Healey JS, Bhatnagar AK, et al. Vernakalant for cardioversion of recent-onset atrial fibrillation: a systematic review and meta-analysis. Europace. 2019;21(8):1159–66. https://doi.org/10.1093/europace/euz175.

    Article  PubMed  PubMed Central  Google Scholar 

  • Patten M, Maas R, Bauer P, et al. Suppression of paroxysmal atrial tachyarrhythmias—results of the SOPAT trial. Eur Heart J. 2004;25:1395–404.

    Article  PubMed  Google Scholar 

  • Pisters R, Hohnloser SH, Connolly SJ, et al. Effect of dronedarone on clinical end points in patients with atrial fibrillation and coronary heart disease: insights from the ATHENA trial. Europace. 2014;16:174–81.

    Article  PubMed  Google Scholar 

  • Platia E, McGovern B, Scheinman MM, et al. Adenosine for paroxysmal supraventricular tachycardia: dose ranging and comparison with verapamil. Ann Intem Med. 1990;113:104–10.

    Article  Google Scholar 

  • Plewan A, Lehmann G, Ndrepepa G, et al. Maintenance of sinus rhythm after electrical cardioversion of persistent atrial fibrillation; sotalol vs bisoprolol. Eur Heart J. 2001;22:1504–10.

    Article  CAS  PubMed  Google Scholar 

  • Podrid PJ, Lampert S, Graboys TB, et al. Aggravation of arrhythmia by antiarrhythmic drugs--incidence and predictors. Am J Cardiol. 1987;59:38E–44E.

    Article  CAS  PubMed  Google Scholar 

  • Pollick C. Muscular subaortic stenosis: hemodynamic and clinical improvement after disopyramide. N Engl J Med. 1982;307:997–9.

    Article  CAS  PubMed  Google Scholar 

  • Preliminary report. Effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. N Engl J Med. 1989;321:406–12.

    Article  Google Scholar 

  • Reimold SC, Chalmers TC, Berlin JA, Antman EM. Assessment of the efficacy and safety of antiarrhythmic therapy for chronic atrial fibrillation: observations on the role of trial design and implications of drug-related mortality. Am Heart J. 1992;124:924–32.

    Article  CAS  PubMed  Google Scholar 

  • Roos JC, Paalman ACA, Dunning AJ. Electrophysiologic effects of mexiletine in man. Br Heart J. 1976;38:62.

    Article  Google Scholar 

  • Rothenberg F, Franklin JO, DeMaio SJ. Use, value, and toxicity of amiodarone. Heart Dis Stroke. 1994;3:19–23.

    CAS  PubMed  Google Scholar 

  • Roy D, Talajic M, Dorian P, et al. Amiodarone to prevent recurrence of atrial fibrillation. Canadian Trial of Atrial Fibrillation Investigators. N Engl J Med. 2000;342:913–20.

    Article  CAS  PubMed  Google Scholar 

  • Roy D, Pratt CM, Torp-Pedersen C, et al. Atrial Arrhythmia Conversion Trial Investigators. Vernakalant hydrochloride for rapid conversion of atrial fibrillation: a phase 3, randomized, placebo-controlled trial. Circulation. 2008;117:1518–25.

    Article  CAS  PubMed  Google Scholar 

  • Sauer AJ, Moss AJ, McNitt S, et al. Long QT syndrome in adults. J Am Coll Cardiol. 2007;49:329–37.

    Article  PubMed  Google Scholar 

  • Scirica BM, Morrow DA, Hod H, et al. E. Effect of ranolazine, an antianginal agent with novel electrophysiological properties, on the incidence of arrhythmias in patients with non ST-segment elevation acute coronary syndrome: results from the Metabolic Efficiency With Ranolazine for Less Ischemia in Non ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) randomized controlled trial. Circulation. 2007;116:1647–52.

    Article  CAS  PubMed  Google Scholar 

  • Singh BN, Wellens HJ, Hockings BE. Electropharmacological control of cardiac arrhythmias. New York, NY: Futura Publishing Co; 1994.

    Google Scholar 

  • Singh BN, Connolly SJ, Crijns HJ, et al. Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter. N Engl J Med. 2007;357:987–99.

    Article  CAS  PubMed  Google Scholar 

  • Sticherling C, Oral H, Horrocks J, et al. Effects of digoxin on acute, atrial fibrillation–induced changes in atrial refractoriness. Circulation. 2000;102:2503–8.

    Article  CAS  PubMed  Google Scholar 

  • Thibault B, Nattel S. Optimal management with Class I and Class III antiarrhythmic drugs should be done in the outpatient setting: protagonist. J Cardiovasc Electrophysiol. 1999;10:472–81.

    Article  CAS  PubMed  Google Scholar 

  • Touboul P, Brugada J, Capucci A, et al. Dronedarone for prevention of atrial fibrillation: a dose-ranging study. Eur Heart J. 2003;24:1481–7.

    Article  CAS  PubMed  Google Scholar 

  • Tsai CF, Chen SA, Tai CT, et al. Idiopathic ventricular fibrillation: clinical, electrophysiologic characteristics and long-term outcomes. Int J Cardiol. 1998;64:47–55.

    Article  CAS  PubMed  Google Scholar 

  • Tsolakas TC, Davies JP, Oram S. Propranolol in attempted maintenance of sinus rhythm after electrical defibrillation. Lancet. 1964;18:1064.

    Article  Google Scholar 

  • Van Noord T, Van Gelder IC, Tieleman RG, et al. VERDICT: the verapamil versus digoxin cardioversion trial: a randomized study on the role of calcium lowering for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2001;12:766–9.

    Article  PubMed  Google Scholar 

  • Vassallo P, Trohman RG. Prescribing amiodarone. An evidence-based review of clinical indications. JAMA. 2007;298:1312–22.

    Article  CAS  PubMed  Google Scholar 

  • Viskin S, Chorin E, Viskin D, et al. Quinidine-responsive polymorphic ventricular tachycardia in patients with coronary Heart Disease. Circulation. 2019;139(20):2304–14.

    Article  CAS  PubMed  Google Scholar 

  • Waldo AL, Camm AJ, de Ruyter H, et al. Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators. Survival with oral d-Sotalol. Lancet. 1996;348:7–12.

    Article  CAS  PubMed  Google Scholar 

  • Weaver WD, Fahrenbruch CE, Johnson DD, et al. Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation. Circulation. 1990;82:2027–34.

    Article  CAS  PubMed  Google Scholar 

  • Yap YG, Camm AJ. Drug induced QT prolongation and torsades de pointes. Heart. 2003;89:1363–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Kathryn L. Hong & Benedict M. Glover

  2. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Paul Dorian

Authors
  1. Kathryn L. Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benedict M. Glover
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Dorian
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada

    Benedict M. Glover

  2. University Hospital of Brussel, Brussels, Belgium

    Pedro Brugada

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hong, K.L., Glover, B.M., Dorian, P. (2021). Anti-Arrhythmic Drugs. In: Glover, B.M., Brugada, P. (eds) Clinical Handbook of Cardiac Electrophysiology. Springer, Cham. https://doi.org/10.1007/978-3-030-74319-2_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-74319-2_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-74318-5

  • Online ISBN: 978-3-030-74319-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation