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A N Mahendra
Procainamide
Dromotropic & chronotropic-negative,
dissociates from INa with intermediate
kinetics, direct SA & AV nodes-depressants
Clinical uses: Most atrial & ventricular
arrhythmias; second choice for most
sustained ventricular as. associated with AMI
1A
PO, IV, IM
M: hepatic (Procainamide NAPA)
E: hepatic, renal
Adverse effects: hypotension, reversible
lupus-related sx (long-term tx).
NAPA: associated with torsades de pointes in
patients with renal failure
1A Miscellaneous Agents
Lidocaine
Blockade of activated & activated fast
kinetics-channels; does not prolong APD
Clinical uses:
VT termination
Prevention of VF after cardioversion
1B
IV
E: hepatic (First-pass metabolism)
HF & liver ds dose reduction
Toxicity: Neurologic sx.
Mexiletine
Lidocaine congener (PO)
Clinical uses: ventricular arrhythmias &
chronic pain syndromes
1C
Flecainide
Dissociates from slow-kinetics channels; does
not change APD
Clinical uses:
Supraventricular arrhythmias (in normal cardiac
tissue)
Do NOT use in post-MI (ischemic conditions)
1C
PO
M: hepatic & renal
Long t1/2 (20 hrs)
Miscellaneous agents
Propafenone: PO, hepatic metabolism, weak
beta-blocking activity; SV arrhythmias
Moricizine: withdrawn (proarrhythmic)
Class 2
Basic PD: Anti-adrenergic activity (β)
Propranolol
Direct membrane effects & prolongs APD;
slows SA node automaticity; negative
dromotropic effect on AV node
Clinical uses:
Atrial arrhythmias
Prevention of:
Recurrent infection
Sudden death
Class 2
PO, parenteral
Toxicity: asthma, AV blockade, acute HF
Interactions: cardiac depressants &
hypotensive agents
Miscellaneous drug:
Esmolol: IV, short-acting; used for intraoperative
& other acute arrhythmias
Class 3
Basic PD: K channel (IKr) blockade
APD modulators
Examples:
Amiodarone
Dofetilide
Sotalol
Ibutilide
Dronedarone
Vernakalant
Amiodarone
INa, IKr, ICa-L channels & beta-adrenoceptors
blockade
APD & QT prolongation
Negative chronotropic & dromotropic effect
Low incidence of torsade de pointes
Clinical uses: serious supraventricular &
ventricular arrhythmias
PO, IV
Variable absorption & tissue accumulation;
hepatic metabolism, slow & complex
elimination
Toxicity: bradycardia & heart block in
diseased heart heart, peripheral vasodilation,
pulmonary, thyroid, & hepatic toxicity
Dofetilide
IKr blockade
APD prolongation, effective refractory period
Clinical uses: Maintenance or restoration of
sinus rhythm in AF
PO; renal excretion
Toxicity: Torsade de pointes (initiate in
hospital)
Additive with other QT-prolonging agents
Sotalol: beta-blocker, prolongs APD; for
ventricular a. & AF
Ibutilide: K-channel blocker, may activate
inward current,; IV use for conversion in atrial
flutter & AF
Dronedarone: investigational
Vernakalant: investigational
Class 4