Antiarrhythmic Drugs

Vaughn-Williams Classification
Class Basic Mechanism Action
I Sodium Channel Blockade Effects on kinetics of Na channel
blockade and APD
II Sympatholytic Reduce cardiac beta-adrenergic
activity
III Prolongation of action potential Block the rapid component of IKr
IV Blockade of cardiac calcium current Slows conduction in SA and AV node

Class I Anti-Arrhythmic
Class Basic Mechanism Action
I Sodium channel Blockade Reduce phase 0 slope and peak of
action potential
IA Moderate − Moderate reduction in phase
0 slope
− Increase APD
− Increase ERP
IB Weak − Small reduction in phase 0
slope
− Reduce APD
− Decrease ERP
IC Strong − Pronounced reduction in
phase 0 slope
− No effect on APD or ERP

Class IA − Quinidine
− Procainamide
− Disopyramide
Interactions: − Codeine
Increase Plasma Concentration of − Flecainide
− Propafenone
Reduces clearance of − Digoxin
Plasma Concentration is decreased by − Phenobarbital
− Phenytoin
Plasma Concentration is Increased by − Cimetidine
− Verapamil
Class IB − Lidocaine
− Mexiletine
− Phenytoin
− Tocainide
Class IC − Flecainide
− Propafenone
− Moricizine
Class II − Beta Blockers
Non Selective Beta Blocker − Propranolol
− Carteolol
− Carvedilol
− Labetalol
− Nadolol
− Penbutolol
− Pindolol
 − Sotalol
− Timolol
B1 Selective Beta Blocker − Acebutolol
− Esmolol
− Atenolol
− Betaxolol
− Bisoprolol
− Metoprolol
Class III − Amiodarone
− Dronadenone
− Beretylium
− Sotalol
− Dofetilide
− Ibutilide
Drug Interaction − Digoxin
Increase Concentration of − Statins
− Warfarin (amiodarone)
After its metabolism − Azole antifungals
− Protease inhibitors (dronedarone)
Class IV − Diltiazem
− Verapamil
Miscellaneous Agents − Adenosine
− Avabradine
− Ranolazine
− Magnesium
− Atropine
Drug Interaction of Adenosine − Theophylline
− Caffeine
− dipyridamole
Clinical Uses of Anti-Arrhythmic Drugs
Sinus Tachycardia − Class II, IV
− Other underlying causes may need treatment
Atrial Fibrillation/Flutter − Class IA, IC, II, II, IV, digitalis
Paroxysmal supraventricular Tachycardia − Class IA, IC, II, III, IV, Adenosine
AV Block − Atropine
− Acute reversal
Ventricular tachycardia − Class I, II, III
Premature Ventricular Complexes − Class II, IV, Mg Salts
− PVC are often benign and do not require
treatment
Digitalis Toxicity − Class IB
− Mg salts
− KCl