Antiarrhythmics

ESC CardioMed ◽  
2018 ◽  
pp. 187-195
Author(s):  
Federico Guerra ◽  
Alessandro Capucci
Keyword(s):  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Clinical Practice ◽  
Adverse Effects ◽  
Antiarrhythmic Drugs ◽  
Therapeutic Window ◽  
Acute Management ◽  
Basic Information ◽  
Narrow Therapeutic Window

Antiarrhythmic drugs are the cornerstone of supraventricular and ventricular arrhythmias therapy. Despite the increasing interest in invasive and ablative approaches to treating many arrhythmias, such as atrial fibrillation and ventricular tachycardia, antiarrhythmic drugs are still widely used for both acute management and chronic prophylaxis. Unfortunately, many antiarrhythmic drugs currently available have a narrow therapeutic window and many issues regarding potential serious adverse effects, proarrhythmic properties, and multiorgan toxicity. The current Vaughan Williams classification of antiarrhythmic drugs is shown in a table. The aim this chapter is to provide basic information regarding the most used compounds in clinical practice.

scholarly journals Antiarrhythmic drugs: mechanisms of action, clinical effects, indications for use

2019 ◽  
Vol 26 (2) ◽  
pp. 76-90
Author(s):  
G. M. Solovyan ◽  
T. V. Mikhalieva
Keyword(s):  
Clinical Practice ◽  
Cardiac Arrhythmias ◽  
Antiarrhythmic Drugs ◽  
Mechanisms Of Action ◽  
Current Evidence ◽  
Clinical Effects ◽  
Trigger Activity ◽  
Impulse Formation ◽  
Indications For Use

The lecture is devoted to one of the most difficult problems of modern cardiology – the use of antiarrhythmic therapy in clinical practice. The basic mechanisms of arrhythmias, aspects of their onset, maintenance and termination are briefly described. The current evidence on the electrophysiological mechanisms of cardiac arrhythmias – re-entry, abnormal impulse formation, and trigger activity – is presented. The article contains information about the remodeling of ion channels properties. The Sicilian gambit is analyzed, in which the mechanisms of arrhythmias are compared to the mechanisms of anti-arrhythmic action of drugs. Classification of anti-arrhythmic drugs, their mechanisms of action, indications and contraindications, side effects, and interaction with other drugs are presented.

Atrial fibrillation and supraventricular arrhythmias

2016 ◽  
Author(s):  
Demosthenes Katritsis ◽  
A John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Definitive Diagnosis ◽  
Acute Management ◽  
Supraventricular Arrhythmias ◽  
Acute Therapy ◽  
Supraventricular Tachycardias

This chapter discusses the acute management of patients presenting with tachyarrhythmias suggestive of regular supraventricular tachycardias (SVT) and/or atrial fibrillation (AF). A classification of narrow- and wide-QRS tachycardias is presented, and the differential diagnosis of narrow- and wide-QRS tachycardias is discussed. Principles of acute therapy are presented either in the context of acute therapy before establishing a definitive diagnosis or for particular arrhythmia entities with an established diagnosis of a regular SVT or AF.

Classification of tachyarrhythmias, mechanisms of arrhythmogenesis, and acute management

2013 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Ventricular Arrhythmias ◽  
Acute Management ◽  
Acute Therapy

Tachyarrhythmias are considered as atrial tachycardias, AVNRT and other junctional arrhythmias, AVRT, atrial fibrillation, and ventricular arrhythmias. The classification, electrophysiological mechanisms, and acute therapy of arrhythmias are presented.

scholarly journals The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

2020 ◽  
Author(s):  
Tatjana S. Potpara ◽  
Gregory Y. H. Lip ◽  
Carina Blomstrom-Lundqvist ◽  
Giuseppe Boriani ◽  
Isabelle C. Van Gelder ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Clinical Practice ◽  
Stroke Risk ◽  
Treatment Options ◽  
Symptom Control ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Treatment Decision Making

AbstractAtrial fibrillation (AF) is a complex condition requiring holistic management with multiple treatment decisions about optimal thromboprophylaxis, symptom control (and prevention of AF progression), and identification and management of concomitant cardiovascular risk factors and comorbidity. Sometimes the information needed for treatment decisions is incomplete, as available classifications of AF mostly address a single domain of AF (or patient)-related characteristics. The most widely used classification of AF based on AF episode duration and temporal patterns (that is, the classification to first-diagnosed, paroxysmal, persistent/long-standing persistent, and permanent AF) has contributed to a better understanding of AF prevention and treatment but its limitations and the need for a multidimensional AF classification have been recognized as more complex treatment options became available. We propose a paradigm shift from classification toward a structured characterization of AF, addressing specific domains having treatment and prognostic implications to become a standard in clinical practice, thus aiming to streamline the assessment of AF patients at all health care levels facilitating communication among physicians, treatment decision-making, and optimal risk evaluation and management of AF patients. Specifically, we propose the 4S-AF structured pathophysiology-based characterization (rather than classification) scheme that includes four AF- and patient-related domains—Stroke risk, Symptoms, Severity of AF burden, and Substrate severity—and provide a hypothetical model for the use of 4S-AF characterization scheme to aid treatment decision making concerning the management of patients with AF in clinical practice.

scholarly journals Newer Oral Anticoagulants: Stroke Prevention and Pitfalls

2016 ◽  
Vol 10 (1) ◽  
pp. 94-104 ◽  
Author(s):  
Anand Patel ◽  
Richard P. Goddeau Jr ◽  
Nils Henninger
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulant Effect ◽  
Therapeutic Window ◽  
Thrombin Inhibitor ◽  
Multiple Drug ◽  
Thrombotic Complication ◽  
Narrow Therapeutic Window ◽  
Increased Risk

Warfarin is very effective in preventing stroke in patients with atrial fibrillation. However, its use is limited due to fear of hemorrhagic complications, unpredictable anticoagulant effects related to multiple drug interactions and dietary restrictions, a narrow therapeutic window, frequent difficulty maintaining the anticoagulant effect within a narrow therapeutic window, and the need for inconvenient monitoring. Several newer oral anticoagulants have been approved for primary and secondary prevention of stroke in patients with non-valvular atrial fibrillation. These agents have several advantages relative to warfarin therapy. As a group, these direct oral anticoagulants (DOAC), which include the direct thrombin inhibitor, dabigatran, and the factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban), are more effective than dose adjusted warfarin for prevention of all-cause stroke (including both ischemic and hemorrhagic stroke), and have an overall more favorable safety profile. Nevertheless, an increased risk of gastrointestinal bleeding (with the exception of apixaban), increased risk for thrombotic complication with sudden discontinuation, and inability to accurately assess and reverse anticoagulant effect require consideration prior to therapy initiation, and pose a challenge for decision making in acute stroke therapy.

Atrial fibrillation and supraventricular arrhythmias

2017 ◽  
Author(s):  
Demosthenes Katritsis ◽  
A John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Definitive Diagnosis ◽  
Acute Management ◽  
Supraventricular Arrhythmias ◽  
Acute Therapy ◽  
Supraventricular Tachycardias

This chapter discusses the acute management of patients presenting with tachyarrhythmias suggestive of regular supraventricular tachycardias (SVT) and/or atrial fibrillation (AF). A classification of narrow- and wide-QRS tachycardias is presented, and the differential diagnosis of narrow- and wide-QRS tachycardias is discussed. Principles of acute therapy are presented either in the context of acute therapy before establishing a definitive diagnosis or for particular arrhythmia entities with an established diagnosis of a regular SVT or AF.

Atrial fibrillation and supraventricular arrhythmias

2015 ◽  
Author(s):  
Demosthenes Katritsis ◽  
A John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Definitive Diagnosis ◽  
Acute Management ◽  
Supraventricular Arrhythmias ◽  
Acute Therapy ◽  
Supraventricular Tachycardias

This chapter discusses the acute management of patients presenting with tachyarrhythmias suggestive of regular supraventricular tachycardias (SVT) and/or atrial fibrillation (AF). A classification of narrow- and wide-QRS tachycardias is presented, and the differential diagnosis of narrow- and wide-QRS tachycardias is discussed. Principles of acute therapy are presented either in the context of acute therapy before establishing a definitive diagnosis or for particular arrhythmia entities with an established diagnosis of a regular SVT or AF.

scholarly journals New progress in understanding the cellular mechanisms of anti-arrhythmic drugs

2018 ◽  
Vol 13 (1) ◽  
pp. 335-339
Author(s):  
Zhe An ◽  
Guang Yang ◽  
Xuanxuan Liu ◽  
Zhongfan Zhang ◽  
Guohui Liu
Keyword(s):  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Side Effects ◽  
Catheter Ablation ◽  
Antiarrhythmic Drugs ◽  
Ionic Currents ◽  
Cellular Mechanisms ◽  
New Targets

AbstractAntiarrhythmic drugs are widely used, however, their efficacy is moderate and they can have serious side effects. Even if catheter ablation is effective for the treatment of atrial fibrillation and ventricular tachycardia, antiarrhythmic drugs are still important tools for the treatment of arrhythmia. Despite efforts, the development of antiarrhythmic drugs is still slow due to the limited understanding of the role of various ionic currents. This review summarizes the new targets and mechanisms of antiarrhythmic drugs.

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