Pharmacotherapy in arrhythmias: an overview of anti-arrhythmic drug therapy

Abstract

The article aims to give an overview of the principles in anti-arrhythmic drug prescribing. Practitioners assessing cardiac patients are highly likely to review anti-arrhythmic drug therapies and need an understanding of the principles of therapy. The cardiac action potential is explained, followed by general principles involved in treating arrhythmias and prescribing decisions. An overview of the five classifications of anti-arrhythmic drugs is given, with examples of the main drugs in the classification and principles to consider within each. Finally anticoagulation is reviewed being a cornerstone prescribing decision in the most common arrhythmia, atrial fibrillation.

Rate vs rhythm: beta blockers and antiarrhythmics as pharmacological options for the treatment of postoperative atrial fibrillation

“…Pharmacological agents such as beta blockers and antiarrhythmic drugs (Figure 1) have been used extensively as prophylaxis and as treatments for POAF. Both types of drugs are wellestablished treatments, but it is how they influence the electrical activity of the heart that determines the category they fall into within the Vaugh Williams classification (Eftekhari 2020). Although there are five classifications this discussion will focus on selected drugs from class II and III because they represent the drugs which are most commonly used in the cardiac surgical intensive care unit.…”

“…Beta blockers have been described as one of the oldest classes of cardiovascular drugs and are the most frequently used in the treatment of arrhythmias such as AF among other cardiovascular diseases (Poirer et al 2013). They affect the SAN and AVN by blocking beta receptors through competitive inhibition, which results in a decrease in sympathetic tone thereby reducing adrenergic activity (Neal 2016& Eftekhari 2020. The consequences of which slows the force and rate of heart contraction, hence reducing the demand for oxygen in myocardial tissue.…”

“…The prevalence of AF is predicted to increase in the future due to an increasingly aged population, with its occurrence approximately doubling with each decade of age. This is a view voiced by many including Eftekhari (2020) and Norhayati et al (2020) who go further and relay the significant repercussions this will have on cardiac mortality and morbidity rates. AF is one of the most recognised complications of cardiac surgery with Piccini et al (2013) and Raiten et al (2015) both indicating an incidence of up to 40% of patients following coronary artery bypass surgery (CABG) and 64% with accompanying valve surgery.…”