Antiarrhythmic

Aka: Antiarrhythmic, Vaughn Williams Classification, Class I Antiarrhythmic Drug, Class 1 Antiarrhythmic, Class Ia Antiarrhythmic Drug, Class Ib Antiarrhythmic Drug, Class Ic Antiarrhythmic Drug, Class II Antiarrhythmic Drug, Class 2 Antiarrhythmic, Class III Antiarrhythmic Drug, Class 3 Antiarrhythmic, Class IV Antiarrhythmic Drug, Class 4 Antiarrhythmic, Sodium Channel Blockade Antiarrhythmic, Sodium Channel Blocker Antiarrhythmic, Potassium Channel Blockade Antiarrhythmic, Potassium Channel Blocker

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II. Mechanism

  1. See Cardiac Action Potential
  2. Images
    1. CardiacActionPotential.png

III. Medications: Class I - Sodium Channel Blockade

  1. Background
    1. Unlike other Antiarrhythmic classes, Class I agents have minimal effect on SA Node automaticity
  2. Class Ia: Lengthens Action Potential duration
    1. Quinidine
    2. Procainamide (Pronestyl)
    3. Disopyramide (Norpace)
    4. Amiodarone (also Class II, III, IV)
    5. Several non-classic Antiarrhythmics have Class Ia activity (e.g. Imipramine, a Tricyclic Antidepressant)
  3. Class Ib: Shortens Action Potential duration
    1. Lidocaine (Xylocaine)
    2. Tocainide (Tonocard)
    3. Mexiletine (Mexitil)
    4. Phenytoin (Dilantin)
  4. Class Ic: Slows conduction
    1. Precautions
      1. Increased proarrhythmia risk and risk of Sudden Cardiac Death
      2. Avoid in structural heart disease, Coronary Artery Disease and Left Ventricular Hypertrophy
      3. Must use with concurrent AV Nodal Blocking agent (e.g. Beta Blocker)
    2. Flecainide (Tambocor)
    3. Encainide (Enkaid)
    4. Propafenone (Rythmol)

IV. Medications: Class II - Beta Blocker

  1. Propranolol
  2. Metoprolol
  3. Atenolol
  4. Carvedilol (Coreg)
  5. Esmolol (Brevibloc)
  6. Sotalol (also Class III)
  7. Amiodarone (also Class Ia, III, IV)

V. Medications: Class III - Blocks potassiun channels, prolongs repolarization

  1. Bretylium (Bretylol)
  2. Sotalol
  3. Amiodarone (also Class Ia, II, IV)
  4. Dofetilide (Tikosyn)
  5. Dronedarone (Multaq)

VI. Medications: Class IV - Calcium Channel Blocker, blocks slow Calcium channel inward current

  1. Verapamil (Calan)
  2. Diltiazem (Cardizem)
  3. Nifedipine
  4. Amiodarone (also Class Ia, II, III)

VII. References

  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 83
  2. Helton (2015) Am Fam Physician 92(9): 793-800 [PubMed]

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Related Studies

Ontology: Anti-Arrhythmia Agents (C0003195)

Definition (NCI) Agents used for the treatment or prevention of cardiac arrhythmias; they may effect the polarization-repolarization phase of the action potential, its excitability or refractoriness, or impulse conduction or membrane responsiveness within cardiac fibers.(CRISP)
Definition (MSH) Agents used for the treatment or prevention of cardiac arrhythmias. They may affect the polarization-repolarization phase of the action potential, its excitability or refractoriness, or impulse conduction or membrane responsiveness within cardiac fibers. Anti-arrhythmia agents are often classed into four main groups according to their mechanism of action: sodium channel blockade, beta-adrenergic blockade, repolarization prolongation, or calcium channel blockade.
Definition (CSP) group of agents used for the treatment or prevention of cardiac arrhythmias; they may effect the polarization-repolarization phase of the action potential, its excitability or refractoriness, or impulse conduction or membrane responsiveness within cardiac fibers.
Concepts Pharmacologic Substance (T121)
MSH D000889
SnomedCT 67507000, 372813008
English Agents, Anti-Arrhythmia, Anti Arrhythmia Agents, antiarrhythmic agent, Agents, Antiarrhythmia, Anti Arrhythmia Drugs, Anti Arrhythmics, Anti-Arrhythmia Drugs, Anti-Arrhythmics, Antiarrhythmia Agents, Antiarrhythmia Drugs, Antiarrhythmic Drugs, Drugs, Anti-Arrhythmia, Drugs, Antiarrhythmia, Drugs, Antiarrhythmic, Antiarrhythmic Agent, ANTIARRHYTHMIA AGENTS, ANTIARRHYTHMICS, antiarrhythmic agents (medication), anti-arrhythimia agents, antiarrhythmic agents, Cardiac Depressant, Antiarrhythmic, Anti-arrhythmic Agent, [CV300] ANTIARRHYTHMICS, Anti-arrhythmic, Anti-arrhythmic Agent [TC], agents antiarrhythmic, antiarrhythmia drugs, antiarrhythmic drugs, anti arrhythmia drugs, anti arrhythmic, antiarrhythmic, anti arrhythmics, anti-arrhythmia drugs, antiarrhythmia agents, anti-arrhythmics, antiarrhythmic drug, antiarrhythmics, Anti-Arrhythmia Agents, Antiarrhythmic drug, Antiarrhythmic agent (substance), Antiarrhythmic agent, Antiarrhythmic drug (product), Antiarrhythmic drug, NOS, Antiarrhythmic drug (substance), antiarrhythmia, Antiarrhythmics
French Médicaments antiarythmiques, Anti-arythmiques, Agents antiarythmiques, Antiarythmisants, Antiarythmiques
Swedish Antiarytmika
Czech antiarytmika
Finnish Rytmihäiriölääkkeet
Italian Farmaci antiaritmia, Farmaci antiaritmici, Antiaritmici
Russian PROTIVOARITMICHESKIE SREDSTVA, MIOKARDIAL'NYE DEPRESSANTY, KARDIAL'NYE DEPRESSANTY, ANTIARITMICHESKIE SREDSTVA, ANTIFIBRILLIATORNYE SREDSTVA, АНТИАРИТМИЧЕСКИЕ СРЕДСТВА, АНТИФИБРИЛЛЯТОРНЫЕ СРЕДСТВА, КАРДИАЛЬНЫЕ ДЕПРЕССАНТЫ, МИОКАРДИАЛЬНЫЕ ДЕПРЕССАНТЫ, ПРОТИВОАРИТМИЧЕСКИЕ СРЕДСТВА
Japanese 抗不整脈薬, 不整脈治療薬, 心筋抑制薬, 心抑制薬, 抗不整脈剤, 抗心臓細動薬
Croatian ANTIARITMIJSKI LIJEKOVI
Polish Leki przeciwarytmiczne, Depresanty mięśnia sercowego, Antyarytmiki, Leki antyarytmiczne
Spanish Antiarrítmicos, Agentes Antiarrítmicos, agente antiarrítmico (sustancia), agente antiarrítmico, antiarrítmicos, antiarrítmico, droga antiarrítmica (producto), droga antiarrítmica (sustancia), droga antiarrítmica, fármaco antiarrítmico (producto), fármaco antiarrítmico
Portuguese Agentes Antiarrítmicos, Antiarrítmicos
German Antiarrhythmika
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Class Ia antiarrhythmic drug (C0304503)

Concepts Pharmacologic Substance (T121)
SnomedCT 373269000, 6122008
English Class Ia antiarrhythmic agent (substance), Class Ia antiarrhythmic agent, Class Ia antiarrhythmic drug (product), Class Ia antiarrhythmic drug, Class Ia antiarrhythmic drug, NOS, Class Ia antiarrhythmic drug (substance)
Spanish agente antiarrítmico clase Ia (sustancia), agente antiarrítmico clase Ia, droga antiarrítmica, clase Ia (sustancia), fármaco antiarrítmico, clase Ia (producto), fármaco antiarrítmico, clase Ia
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Class Ib antiarrhythmic drug (C0304504)

Concepts Pharmacologic Substance (T121)
SnomedCT 373286006, 80066008
English Class Ib antiarrhythmic agent (substance), Class Ib antiarrhythmic agent, Class Ib antiarrhythmic drug (product), Class Ib antiarrhythmic drug, Class Ib antiarrhythmic drug, NOS, Class Ib antiarrhythmic drug (substance)
Spanish agente antiarrítmico, clase Ib (sustancia), agente antiarrítmico, clase Ib, droga antiarrítmica, clase Ib (sustancia), fármaco antiarrítmico, clase Ib (producto), fármaco antiarrítmico, clase Ib
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Class Ic antiarrhythmic drug (C0304505)

Concepts Pharmacologic Substance (T121)
SnomedCT 373290008, 86317005
English Class Ic antiarrhythmic agent (substance), Class Ic antiarrhythmic agent, Class Ic antiarrhythmic drug (product), Class Ic antiarrhythmic drug, Class Ic antiarrhythmic drug, NOS, Class Ic antiarrhythmic drug (substance)
Spanish agente antiarrítmico, clase Ic (sustancia), agente antiarrítmico, clase Ic, droga antiarrítmica, clase Ic (sustancia), fármaco antiarrítmico, clase Ic (producto), fármaco antiarrítmico, clase Ic
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Class I antiarrhythmic drug (C0360692)

Concepts Pharmacologic Substance (T121)
SnomedCT 371179002, 49590009, 373260001
English Class I antiarrhythmic agent (product), Class I antiarrhythmic, Class I antiarrhythmic agent (substance), Class I antiarrhythmic agent, Class I antiarrhythmic drug (product), Class I antiarrhythmic drug, Class I antiarrhythmic drug, NOS, Class I antiarrhythmic drug (substance)
Spanish agente antiarrítmico, clase I, agente antiarrítmico, clase I (producto), agente antiarrítmico clase I (sustancia), agente antiarrítmico clase I, droga antiarrítmica, clase I (sustancia), fármaco antiarrítmico, clase I (producto), fármaco antiarrítmico, clase I
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Class II antiarrhythmic drug (C0360701)

Concepts Pharmacologic Substance (T121)
SnomedCT 371183002, 69227005, 373278006
English Class II antiarrhythmic agent (product), Class II antiarrhythmic, Class II antiarrhythmic agent (substance), Class II antiarrhythmic agent, Class II antiarrhythmic drug (product), Class II antiarrhythmic drug, Class II antiarrhythmic drug, NOS, Class II antiarrhythmic drug (substance), Antiarrhythmics - Class II
Spanish agente antiarrítmico, clase II (producto), agente antiarrítmico, clase II (sustancia), agente antiarrítmico, clase II, droga antiarrítmica, clase II (sustancia), fármaco antiarrítmico, clase II (producto), fármaco antiarrítmico, clase II
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Class III antiarrhythmic drug (C0360703)

Concepts Pharmacologic Substance (T121)
SnomedCT 371184008, 79808008, 372855004
English antiarrhythmics class iii, antiarrhythmic class drugs iii, class iii antiarrhythmic drug, Class III antiarrhythmic agent (product), Class III antiarrhythmic, Class III antiarrhythmic agent (substance), Class III antiarrhythmic agent, Class III antiarrhythmic drug (product), Class III antiarrhythmic drug, Class III antiarrhythmic drug, NOS, Class III antiarrhythmic drug (substance), Antiarrhythmics - Class III
Spanish agente antiarrítmico, clase III, agente antiarrítmico, clase III (producto), agente antiarrítmico clase III (sustancia), agente antiarrítmico clase III, droga antiarrítmica, clase III (sustancia), fármaco antiarrítmico, clase III (producto), fármaco antiarrítmico, clase III
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Class IV antiarrhythmic drug (C0360706)

Concepts Pharmacologic Substance (T121)
SnomedCT 371185009, 29883004, 372693007
Spanish droga antiarrítmica, clase IV, agente antiarrítmico, clase IV (producto), agente antiarrítmico, clase IV, agente antiarrítmico clase IV (sustancia), agente antiarrítmico clase IV, droga antiarrítmica, clase IV (producto), droga antiarrítmica, clase IV (sustancia), fármaco antiarrítmico, clase IV (producto), fármaco antiarrítmico, clase IV
English Class IV antiarrhythmic agent (product), Class IV antiarrhythmic, Class IV antiarrhythmic agent (substance), Class IV antiarrhythmic agent, Class IV antiarrhythmic drug (product), Class IV antiarrhythmic drug, Class IV antiarrhythmic drug, NOS, Class IV antiarrhythmic drug (substance), Antiarrhythmics - Class IV
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Potassium Channel Blockers (C0872245)

Definition (MSH) A class of drugs that act by inhibition of potassium efflux through cell membranes. Blockade of potassium channels prolongs the duration of ACTION POTENTIALS. They are used as ANTI-ARRHYTHMIA AGENTS and VASODILATOR AGENTS.
Concepts Pharmacologic Substance (T121)
MSH D026902
SnomedCT 415151000, 415152007
French Bloqueurs du canal potassique, Inhibiteurs du canal potassium, Inhibiteurs des canaux potassiques, Inhibiteurs du canal potassique, Bloqueurs des canaux potassium, Inhibiteurs des canaux potassium, Bloqueurs des canaux potassiques, Antagonistes des canaux potassiques
Swedish Kaliumkanalblockerare
English K CHANNEL BLOCK, CHANNEL BLOCK K, potassium channel blockers, potassium channel blocker, Blockers, Potassium Channel, Channel Blockers, Potassium, Potassium Channel Blockers, Potassium channel antagonist (product), Potassium channel antagonist (substance), Potassium channel antagonist, Potassium channel blocker
Czech draslíkové kanály - blokátory
Finnish Kaliumkanavansalpaajat
Russian BLOKATORY KALIEVYKH KANALOV, KALIEVYKH KANALOV BLOKATORY, KANALOV KALIEVYKH BLOKATORY, БЛОКАТОРЫ КАЛИЕВЫХ КАНАЛОВ, КАЛИЕВЫХ КАНАЛОВ БЛОКАТОРЫ, КАНАЛОВ КАЛИЕВЫХ БЛОКАТОРЫ
Japanese カリウムチャネル遮断薬, カリウムチャネル遮断剤, カリウムチャンネル遮断剤, Kチャネル遮断剤, Kチャネル遮断薬
Spanish Bloqueantes de los Canales de Potasio, antagonista del canal de potasio (producto), antagonista del canal de potasio (sustancia), antagonista del canal de potasio, bloqueante del canal de potasio, Bloqueadores de los Canales de Potasio
Polish Blokery kanałów potasowych
German Kaliumkanal-Blocker, Kanalblocker, Kalium-
Italian Bloccanti del canale del potassio
Portuguese Bloqueadores dos Canais de Potássio
Derived from the NIH UMLS (Unified Medical Language System)

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