Pharmacologic management of cardiac arrhythmias

Abstract

Management of cardiac arrhythmias involves antiarrhythmic drugs (AADs), catheter ablation, pacemakers, and implantable defibrillators. The effects of AADs are mediated by blocking various cardiac ion channels, mostly the cardiac sodium, calcium, or potassium channels. A simple classification of AADs based upon the target sites of drug action is useful for clinical application of AADs for common cardiac arrhythmias. Atrioventricular nodal blocking agents are useful for management of tachycardias with the atrioventricular node as a part of the reentrant circuit. Membrane active AADs are used for tachycardias occurring within the atrium or ventricle. Recent large randomized clinical trials have failed to show any beneficial effects of AADs for reducing cardiac mortality in patients with heart failure and at risk of sudden cardiac death or in patients with atrial fibrillation. In spite of these limitations, AAD medication remains an important initial or adjunctive therapy in the management of cardiac arrhythmias. © Korean Medical Association.