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Antiarrhythmic Agents

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Current Cardiovascular Drugs

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Abstract

In recent years there has not been a great influx of new antiarrhythmic agents for clinical use besides the introduction of ibutillde and dofetilide, drugs that are mainly used to treat supraventricular tachyarrhythmias. Azimilide, with its unique pharmacological profile, may prove to be a beneficial agent in the treatment of ventricular tachyarrhythmias. In addition, the implantable cardioverter defibrillator has become a standard therapy for life-threatening ventricular arrhythmias, limiting the use of antiarrhythmic drugs except as adjunctive therapy.

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Suggested Bibliography

  • Anderson JL, Jolivette DM, Fredell PA: Summary of efficacy and safety of flecainide for supraventricular arrhythmias. Am J Cardiol 1988, 62: 62D – 66D.

    Article  PubMed  CAS  Google Scholar 

  • Antman EM, Beamer AD, Cantillon C. et al.: Long-term oral propafenone therapy for suppression of refractory symptomatic atrial fibrillation and atrial flutter. J Am Coll Cardiol 1988, 12: 1005–1011.

    Article  PubMed  CAS  Google Scholar 

  • Burkart F, Pfisterer M, Kiowski W, et al.: Effect of antiarrhythmic therapy on mortality in survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias: Basel Antiarrhythmic Study of Infarct Survival (BASIS). J Am Coll Cardiol 1990, 16: 1711–1718.

    Article  PubMed  CAS  Google Scholar 

  • Cairns JA, Connolly SJ, Gent M, Roberts R: Post-myocardial infarction mortality in patients with ventricular premature depolarizations: Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Pilot Study. Circulation 1991, 84: 550–557.

    Article  PubMed  CAS  Google Scholar 

  • Cairns JA, Connolly SJ, Roberts R, et al.: for the Canadian Amiodarone Myocardial Infarction (CAMIAT) Investigators: Randomized trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarizations: CAMIAT. Lancet 1997, 349: 675–682.

    Article  PubMed  CAS  Google Scholar 

  • Campbell TI: Clinical use of class la antiarrhythmic drugs. in Handbook of Experimental Pharmacology: Antiarrhythmic Drugs. Edited by Vaughan Williams EM. Heidelberg: Springer Verlag; 1989:175–2(X).

    Google Scholar 

  • Capucci A, Lenzi T, Boriani G. et al: Effectiveness of loading oral flecainide for converting recent-onset atrial fibrillation to sinus rhythm in patients without organic heart disease or with only systemic hypertension. Am J Cardiol 1992, 70: 69–72.

    Article  PubMed  CAS  Google Scholar 

  • Cavusoglu E, Frishman WH: Sotalol: a new R-adrenergic blocker for ventricular arrhythmias. Prog Cardiovasc Dis 1995, 37: 423–440.

    Article  PubMed  CAS  Google Scholar 

  • Coplen SE, Amman EH, Berlin JE, 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: 1106–1116.

    Article  PubMed  CAS  Google Scholar 

  • Cruickshank JM, Prichard BNC: Arrhythmias. in Beta Blockers in Clinical Practice. London: Churchill; 1987: 577–636.

    Google Scholar 

  • Daoud E, Strickberger S, Man K. et al.: Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Engl J Med 1997, 337: 1785–1791.

    Article  PubMed  CAS  Google Scholar 

  • Dara At, Pollak A, Dubrey S, et al.: Positive atrial inotropic effects of dofetilide following cardioversion of atrial fibrillation [abstract]. J Am Coll Cardiol 1998, 31 (2 Suppl A): 432A.

    Google Scholar 

  • Dolak GL for the CASCADE Investigators: Clinical predictors of implantable cardioverter-defibrillator shocks (results of the CASCADE trial). Am J Cardiol 1994, 73: 237–241.

    Article  Google Scholar 

  • Donovan KD, Power BM, Hockings BE, et al.: Intravenous flecainide versus amiodarone for recent onset atrial fibrillation. Am J Cardiol 1995, 75: 693–697.

    Article  PubMed  CAS  Google Scholar 

  • Doval HC, Nul DR, Grancelli HO, et al., for Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA): Randomized trial of low-dose amiodarone in severe congestive heart failure. Lancet 1994, 344: 493–498.

    Article  PubMed  CAS  Google Scholar 

  • Ellenbogen KA, Stambler BS, Wood MA, et al.: Efficacy of intravenous inutilide for rapid termination of atrial fibrillation and atrial flutter: a dose-response study. JAm Coll Cardiol 1996, 28: 130–136.

    Article  CAS  Google Scholar 

  • Ferreira E, Sunderji R, Gin K: is oral sotalol effective in converting atrial fibrillation to sinus rhythm’? Pharmacotherapy 1997, 17: 1233–1237.

    PubMed  CAS  Google Scholar 

  • Frishman WH, Vandat S, Bhatta S: innovative pharmacologie approaches to cardiopulmonary resuscitation. J Clin Pluxrntacol 1998, 38: 765–772.

    CAS  Google Scholar 

  • Gottlieb CD, Horowitz LN: Potential interactions between antiarrhythmic medication and the automatic implantable cardioverter defibrillator. Pacing Clin Electrophysiol 1991, 14: 898–904.

    Article  PubMed  CAS  Google Scholar 

  • Gottlieb SS: The use of antiarrhythmic agents in heart failure: implications of CAST. Am Heart J 1989, 118: 1074–1077.

    Article  PubMed  CAS  Google Scholar 

  • Greene HL: The efficacy of amiodarone in the treatment of ventricular tachycardia or ventricular fibrillation. Prog Cardiovasc Dis 1989, 31: 439–446.

    Article  Google Scholar 

  • Guarnieri T, Nolan S, Gottlieb SO. et al.: Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery: The Amiodarone Reduction in Coronary Heart (ARCH) Trial. JAm Coll Cardiol 1999; 34: 343–347.

    Article  CAS  Google Scholar 

  • Hagemeijer F: Verapamil in the management of supraventricular tachyarrhythmias occurring after a recent myocardial infarction. Circulation 1978, 57: 751–755.

    Article  PubMed  CAS  Google Scholar 

  • Halinen MO, Huttunen M, Paakkinen S, et al.: Comparison of sotalol with digoxin-quinidine for conversion of acute atrial fibrillation to sinus rhythm (the Sotalol-Digoxin-Quinidine Trial). Am J Cardiol 1995, 76: 495–498.

    Article  PubMed  CAS  Google Scholar 

  • Harron DWG, Shanks RG: Clinical use of class lb antiarrhythmic drugs. In Handbook of Experimental Pharmacology: Antiarrhythmic Drugs. Edited by Vaughan Williams EM. Heidelberg: Springer Verlag; 1989: 201–234.

    Chapter  Google Scholar 

  • Hessen SE, Michelson EL: Antiarrhythmic drugs. in Cardiovascular Pharmacotherapeutics. Edited by Frishman WH, Sonnenblick EH. New York: McGraw Hill; 1997: 281–322.

    Google Scholar 

  • Hine LK, Laird N, Hewitt P, et al.: Meta-analytic evidence against prophylactic use of lidocaine in acute myocardial infarction. Arch Intern Med 1989, 149: 2694–2698.

    Article  PubMed  CAS  Google Scholar 

  • Hombach V, Braun V, Hopp HW. et al.: Electmphysiological effects of cardioselective and non-selective beta-adrenoceptor blockers with and without iSA at rest and during exercise. Br J Clin Pharmacol 1982, 13: 2855–293S.

    Article  Google Scholar 

  • Hood MA, Smith WM: Adenosine versus verapamil in the treatment of supraventricular tachycardia: a randomized double-crossover trial. Am Heart J 1992, 123: 1543–1549.

    Article  PubMed  CAS  Google Scholar 

  • IMPACT Research Group: International Mexiletine and Place-ho Antiarrhythmic Coronary Trial (IMPACT). II: results from 24 hour electrocardiogram. Eur Heart J 1986, 7: 749–759.

    Google Scholar 

  • Indolfi C, Piscione F, Russolillo E. et al.: Digoxin-induced vasoconstriction of normal and atherosclerotic epicardial coronary arteries. Am J Cardiol 1991, 68: 1274–1278.

    Article  PubMed  CAS  Google Scholar 

  • Julian DG, Camm AJ, Frangin G, et al., For the European Myocardial Infarct Amiodarone Trial (EMIAT) Investigators: Randomized trial of effect of amiodarone on mortality in patients with left ventricular dysfunction after recent myocardial infarction: EMIAT. Dancer 1997, 349: 667–674.

    CAS  Google Scholar 

  • Juul-Moller S, Edvardsson N, Rehnqvist-Ahlberg N: Sotalol versus quinidine for the maintenance of sinus rhythm after direct current conversion of atrial fibrillation. Circulation 1990, 82: 1932–1939.

    Article  PubMed  CAS  Google Scholar 

  • Kaber L, The Danish Investigations of Arrhythmia and Mortality on Dofetilide (DIAMOND) Study Group: Dofetilidc, a new class Ill antiarrhythmic drug reduces hospital admis-sions for congestive heart failure: secondary endpoints of the DIAMOND-CHF study [abstract]. J Am Coll Cardio1 1998, 31 (2 Suppl A): 33A.

    Article  Google Scholar 

  • Kgrin NZ, Faitel K, Naini M: The efficacy of intravenous amiodarone for the conversion of chronic atrial fibrillation: amiodaronc vs quinidine for conversion of atrial fibrillation. Arch Intern Med 1996, 156: 49–53.

    Article  Google Scholar 

  • Kober L, The DIAMOND Study Group: Dofetilide improves heart failure in patients with atrial fibrillation and left ventricular dysfunction: a Diamond subanalysis [abstract]. J Am Coll Cardiol 1999, 33 (2 Suppl A): 186A.

    Google Scholar 

  • Kochiadakis GE, Igoumenidis NE, Marketou ME et al.: Low-dose amiodarone versus sotalol for suppression of recurrent symptomatic atrial fibrillation. Am J Cardiol 1998, 81: 995–998.

    Article  PubMed  CAS  Google Scholar 

  • Kudenchuk PJ, Cobb LA, Copass MK. et al.: Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med 1999, 341: 871–878.

    Article  PubMed  CAS  Google Scholar 

  • Kumar A: Intravenous amiodarone for therapy of atrial fibrilla- tion and flutter in critically ill patients with severe depressed left ventricular function. South Med J 1996, 89: 779–785.

    Article  PubMed  CAS  Google Scholar 

  • Larbuisson R, Venneman I, Stiels B: The efficacy and safety of intravenous propafenone versus intravenous amiodarone in the conversion of atrial fibrillation or flutter after cardiac surgery. J Cardiothorac Vast. Anesth 1996, 10: 229–234.

    Article  CAS  Google Scholar 

  • Lee JT, Kroemer HK, Silberstein DJ, et al.: The role of genetically determined polymorphic drug metabolism in the beta blockade produced by propafenone. N Engl J Med 1990, 322: 1764–1768.

    Article  PubMed  CAS  Google Scholar 

  • Lehinan R, Greenbaum RA, Campbell TI, et al.: Patients longer QT (QTc) interval are more likely to remain in sinus rhythm after one year treatment on dofetilide: The search on Atrial Fibrillation Dofetilide) study [abstract]. Am Call Cardiol 1999, 33 (2 Suppl A): 132A.

    Google Scholar 

  • Morganroth J, Chen CC, Sturm S. Dreifus LS: Oral verapamil in the treatment of atrial fibrillation/flutter. Ant J Cardin’ 1982, 49: 981–985.

    Google Scholar 

  • Moss AI, Hall WI, Cannon DS, et al.: Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia: Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996, 335: 1933–1940.

    Article  PubMed  CAS  Google Scholar 

  • Nicklas IM, McKenna WJ, Stewart RA. et al.: Prospective. double-blind. placebo-controlled trial of low-dose amiodamne in patients with severe heart failure and asymptomatic frequent ventricular ectopy. Am Heart J 1991, 122: 1016–1021.

    Article  PubMed  CAS  Google Scholar 

  • Parker RB, McCollum PL, Bauman JL: Propafenone: a novel type lc antiarrhythmic agent. Drug Intel Clin Pharm 1989, 23: 196–203.

    CAS  Google Scholar 

  • Petersen TR for the Norwegian Multicenter Study Group: Six year follow up of the Norwegian Multicenter Study on timolol after acute myocardial infarction. N Engl J Med 1985, 313: 1055–1058.

    Article  Google Scholar 

  • Pfisterer ME, Kiowski W, Brunner H. et al.: Long-term benefit of I year amiodarone treatment for persistent complex ventricular arrhythmias after myocardial infarction. Circulation 1993, 87: 309–311.

    Article  PubMed  CAS  Google Scholar 

  • Schofield PM, Reid F, Bennett DH: A comparison of atenolol and sotalol in the treatment of patients with paroxysmal supraventricular tachycardia. Br Heart J 1987, 57: 105–106.

    Google Scholar 

  • Siebel J, Cappato R, Rüppel R. et al. and the CASH Investigators: ICD versus drugs in cardiac arrest survivors: preliminary results of the Cardiac Arrest Study, Hamburg. PACE 1993. 16: 552–558.

    Article  Google Scholar 

  • Singh BN, Ellrodt G, Peters T: Verapamil: a review of its pharmacological properties and therapeutic use. Drugs 1978, 15: 169–197.

    Article  PubMed  Google Scholar 

  • Singh SN, Berk MR, Yellen LG, et al.: Oral dofetilide for conversion of patients with chronic atrial fibrillation or atrial flutter to normal sinus rhythm: a multicenter study [abstract]. J Am Coll Cardiol 1998, 31 (2 Suppl A): 369A.

    Article  Google Scholar 

  • Singh SN, Berk MR, Yellen LG, et al.: Efficacy and safety of dofetilide in maintaining normal sinus in patients with atrial fibrillation/flutter: a multicenter study [abstract]. Circulation 1997, 96: 383.

    Google Scholar 

  • Singh SN, Galk R, Farahi J, et al.: Restoration of sinus rhythm in subjects with atrial fibrillation improves exercise capacity: a SAFIRE-D (Symptomatic Atrial Fibrillation Investigative Research on Dofetilide) Substudy [abstract]. Circulation 1998, 98 (Suppl 1): 432.

    Google Scholar 

  • Singh SN, Fletcher RD, Fisher SG, et al. for the Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure: Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmias. N Engl J Med 1995, 333: 77–82.

    Article  PubMed  CAS  Google Scholar 

  • Skluth H, Grauer K, Gums J: Ventricular arrhythmias: an assessment of newer therapeutic agents. Postgrad Med 1989, 85: 137–153.

    PubMed  CAS  Google Scholar 

  • Stambler BS, Wood MA, Ellenboken KA: Comparative efficacy of intravenous ibutilide versus procainamide for enhancing termination of atrial flutter by atrial overdrive pacing. Am J Cordial 1996, 77: 960–966.

    Article  CAS  Google Scholar 

  • Steinbeck G, Andersen D, Bach P. et al.: A comparison of electrophysiologically and guided antiarrhythmic drug therapy with beta blocker therapy in patients with symptomatic sustained ventricular tachyarrhythmias. N Engl J Med 1992, 327: 987–992.

    Article  PubMed  CAS  Google Scholar 

  • Strasberg B, Arditti A, Sclarovsky S. et al.: Efficacy of intravenous amiodarone in the management of paroxysmal or new atrial fibrillation with fast ventricular response. lnt J Cardinl 1985, 7: 47–58.

    CAS  Google Scholar 

  • Task Force of the Working Group on Arrhythmias of the European Society of Cardiology: The Sicilian Gambit: a new approach to the classification of antiarrhythmic drugs and their actions on arrhythmogenic mechanisms. Circulation 1991, 84: 1831–1851.

    Article  Google Scholar 

  • Teo KT, Yusuf S, Furberg CD: Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction: an overview of results from randomized controlled trials. JAMA 1993, 270: 1589–1595.

    Article  PubMed  CAS  Google Scholar 

  • The AVID Investigators: A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near fatal ventricular arrhythmias. N Engl J Med 1997, 337: 1576–1583.

    Article  Google Scholar 

  • The Cardiac Arrhythmia Suppression Trial (CAST) Investigators: Preliminary report: effect of encainide and flecanide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989, 321: 406–412.

    Article  Google Scholar 

  • The Cardiac Arrhythmia Suppression Trial II Investigators: Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med 1992, 327: 227–233.

    Article  Google Scholar 

  • The ESVEM Investigators: Determinants of predicted efficacy of antiarrhythmic drugs in the Electrophysiologic Study Versus Electrocardiographic Monitoring trial. Circulation 1993, 87: 323–329.

    Article  Google Scholar 

  • Torp-Pedersen C, Moller M, Bloch-Thomsen PE, et al. for the Danish Investigations on Arrhythmia and Mortality on Dofetilide (DIAMOND) Study Group: Dofetilide in patients with congestive heart failure and left ventricular dysfunction. N Engl J Med 1999; 341: 857–865.

    Article  PubMed  CAS  Google Scholar 

  • Vaughan Williams EM: Classification of antiarrhythmic action. In Handbook of Experimental Pharmacology: Antiar-rhythmic Drugs. Edited by Vaughan Williams EM. Heidelberg: Springer Verlag; 1989: 45–67.

    Google Scholar 

  • Waldo AL, Camm AJ, De Ruyter H, et al.: Effects of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. Lancet 1996, 348: 7–12.

    Article  PubMed  CAS  Google Scholar 

  • Wit AL, Hoffman BF, Rosen MR: Electrophysiology and pharmacology of cardiac arrhythmias. IX: cardiac electrophysiological effects of beta-adrenergic receptor stimulation and blockade. Am Heart J 1975, 90: 795–803.

    Article  PubMed  CAS  Google Scholar 

  • Wit AL, Rosen MR, Hoffman BF: Relationship of normal and abnormal electrical activity of cardiac fibers to the genesis of arrhythmias. II: Re-entry. An: Heart J 1974, 88: 798–807.

    Article  CAS  Google Scholar 

  • Woosley RL, Tang T, Stone W: Pharmacology. electrophysiology, and pharmacokinetics of mexiletine. Am Heart J 1984, 107: 1058–1065.

    Article  PubMed  CAS  Google Scholar 

  • Wyse DG, Morganroth J, Leidengham R, et al.: New insights into the definition and meaning of proarrhythmia during initiation of antiarrhythmic drug therapy from the Cardiac Arrhythmia Suppression Trial and its pilot study. JAm C Cardiol 1994, 23: 1130–1140.

    Article  CAS  Google Scholar 

  • Zaremski DG, Nolan PE Jr, Slack MK, et al.: Treatment of tant atrial fibrillation: A meta-analysis comparing amiodaroi and flecainide. Arch Intern Med 1995, 155: 1885–1891.

    Article  Google Scholar 

  • Zehender M, Hohnloser S, Mueller B. et al.: Effects of amiodarone versus quinidine and verapamil in patients wt chronic atrial fibrillation: results of a comparative stud and a 2-year follow-up. J Am Coll Cardinl 1992, 19: 1054–1059.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Westchester Medical Center, New York Medical College, Valhalla, New York, USA

    William H. Frishman M.D. (Professor of Medicine and Pharmacology, Chairman of Medicine, Director of Medicine)

  2. Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA

    Angela Cheng-Lai Pharm.D. (Clinical Pharmacy Manager, Adult Medicine, Assistant Professor of Medicine) & Julie Chen Pharm.D., BCPS (Clinical Pharmacy Manager, Critical Care, Assistant Professor of Medicine)

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Editors and Affiliations

  1. Westchester Medical Center, New York Medical College, Valhalla, New York, USA

    William H. Frishman M.D. (Professor of Medicine and Pharmacology, Chairman of Medicine, Director of Medicine) (Professor of Medicine and Pharmacology, Chairman of Medicine, Director of Medicine)

  2. Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA

    Angela Cheng-Lai Pharm.D. (Clinical Pharmacy Manager, Adult Medicine, Assistant Professor of Medicine) & Julie Chen Pharm.D., BCPS (Clinical Pharmacy Manager, Critical Care, Assistant Professor of Medicine) (Clinical Pharmacy Manager, Adult Medicine, Assistant Professor of Medicine) &  (Clinical Pharmacy Manager, Critical Care, Assistant Professor of Medicine)

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Frishman, W.H., Cheng-Lai, A., Chen, J. (2000). Antiarrhythmic Agents. In: Frishman, W.H., Cheng-Lai, A., Chen, J. (eds) Current Cardiovascular Drugs. Current Medicine Group, London. https://doi.org/10.1007/978-1-4615-6767-7_6

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  • DOI: https://doi.org/10.1007/978-1-4615-6767-7_6

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