Anti - arrhythmic

Agents
CLASSIFICATION
• Class I – Na+ Channel Blockers
• Class II – Beta blockers
• Class III – K+ Channel Blockers
• Class IV - Ca++ Channel Blockers
CLASS IA
• FAST Channel

• QUINIDINE
• PROCAINAMIDE
• DISOPYRAMIDE
CLASS IA
• MOA:

BLOCKADE of the Na channels

prolong the Action potential duration (APD)

• dissociate from the channel with intermediate kinetics

CLASS IA
• Depress Phase 0
• slow conduction moderately
• prolong membrane repolarization
 CLASS IA USE/s Side effects

QUINIDINE maintenance of cinchonism

normal sinus rhythm
in patients with atrial
flutter or fibrillation
PROCAINAMIDE most atrial and Anticholinergic
ventricular SLE-like
NAPA-metabolite arrhythmias (common in patients
with ganglion- deficient in N-
blocking properties acetyltransferase)

DISOPYRAMIDE is approved only for Anticholinergic

the treatment of
ventricular
arrhythmias.
CLASS IB
Effects:
• Modest depression of conduction
• Shorten membrane repolarization
• have no significant effects on the APD
• dissociate from the channel with rapid kinetics
CLASS IB
• Examples:
LIDOCAINE
MEXILITINE
PHENYTOIN
TOCAINIDE
CLASS IB USES SIDE EFFECTS

LIDOCAINE agent of choice for paresthesias

termination of , tremor
Xylidides - ventricular
metabolite tachycardia

suitable for
arrhythmias arising
during
ischemic episodes
such as myocardial
infarction (MI)
CLASS IB USES SIDE EFFECTS

MEXILITINE treatment of neurologic

ventricular
arrhythmias.
CLASS IC
• Depress Phase 0
• short depression on conduction
• mild or no effect on repolarization
• minimal effects on the APD
• dissociate from the channel with slow kinetics.
CLASS IC
• Examples:
FLECAINIDE
PROFAPENONE
MORICIZINE
CLASS IC USES SIDE EFFECTS
FLECAINIDE •supraventricular
arrhythmias
•very effective in
suppressing
premature ventricular
contractions.
PROPAFENONE used primarily for metallic taste
supraventricular and
arrhythmias constipation

MORICIZINE treatment of dizziness and

----phenothiazine ventricular nausea
derivative arrhythmias
CLASS II – BETA BLOCKERS
• Sympathetic blockers

• PROPRANOLOL
• ESMOLOL
• ACEBUTOLOL
CLASS III – K+ Channel Blockers
• Drugs That Prolong Effective Refractory Period by Prolonging
Action Potential

• Prolong repolarization and increase refractoriness

CLASS III – K+ Channel Blockers
• Examples:
BRETYLIUM
IBUTILIDE
DOFETILIDDE
AMIODARONE
SOTALOL

• undesirable property :
"reverse use-dependence“
CLASS III USES SIDE EFFECTS
AMIODARONE serious ventricular pulmonary FIBROSIS
arrhythmias gray-blue skin
Desethylamiodarone highly effective for discoloration
active metabolite the treatment of photosensitivity
supraventricular
arrhythmias such hypothyroidism or
as atrial fibrillation hyperthyroidism
HEPATOTOXIC
torsade de pointes
BRETYLIUM used in an Postural hypotension
emergency setting Nausea and vomiting
to resuscitate from
vent. Fibrillation
when lidocaine
and cardioversion
have failed.
CLASS III USES SIDE EFFECTS
SOTALOL supraventricular
and ventricular
arrhythmias in the
pediatric age
group
DOFETILIDE maintenance of
normal sinus
rhythm in patients
with atrial
fibrillation.
IBUTILIDE acute conversion torsade de pointes
of atrial flutter to ----prolong QT
normal sinus interval
rhythm.
CLASS III USES
DRONEDARONE Restores sinus Withdrawn in 2011
rhythm in patients because of
“black box” warning with atrial increased risk of
fibrillation death, stroke and
Analog of Amiodarone HF

VERNAKALANT Atrial fibrillation Multi-ion channel

- Prolongs atrial blocker
effective refractory
period and slows Produces use-
conduction over dependent block of
the AV node the Sodium channel
CLASS IV – Ca++ CHANNEL BLOCKERS
• SLOW CHANNEL BLOCKERS
• MOA:
blockade of the cardiac calcium current.

slows conduction in the sinoatrial and atrioventricular nodes.

CLASS IV USES SIDE EFFECTS

VERAPAMIL Supraventricular Hypotension

tachycardia AV block

ideal drug for both

immediate and
prophylactic
therapy of
supraventricular
tachycardia (SVT)
CLASS IV USES SIDE EFFECTS

DILTIAZEM management of Hypotension

supraventricular
arrhythmias,
including rate control
in atrial fibrillation

BEPRIDIL ventricular
arrhythmias
 MISCELLANEOUS AGENTS
• Certain agents used for the treatment of arrhythmias do not fit the
conventional class 1–4 organization.
• These include:
Digitalis
Adenosine
Magnesium
Potassium
CLASS IV USES SIDE EFFECTS
Adenosine drug of choice for flushing
---hyperpolarization paroxysmal shortness of breath
and suppression of supraventricular chest burning
calcium-dependent tachycardia Induction of high-
action potentials grade AV block
Magnesium ---for patients with
--influence Na+/K+ digitalis-induced
ATPase, sodium arrhythmias
channels, certain ---indicated in some
potassium channels, patients with torsade de
and calcium channels. pointes
Potassium Hyperkalemia
---depresses ectopic
pacemakers (severe
hyperkalemia is
required to suppress
the sinoatrial node) and
slows conduction.