Arrhythmias

Arrhythmias (see 6.33 Antiarrythmics) are disorders of cardiac rhythm that lead to nearly 40000 deaths annually.1 Arrhythmias also are observed following CHF or MI. Arrhythmias can occur at various levels of the heart including the atria, the atrioventricular node, and the ventricles. Arrhythmias of the ventricles are believed to be the primary factor in sudden cardiac death from coronary artery disease. These disorders are difficult to manage either pharmacologically or via invasive techniques such as ablation. Pharmacological agents used to manage cardiac arrhythmias are often classified according to their primary mechanism of action into four major categories. While they range in mechanism of action from sodium channel (Class 1A (procaineamide), 1B (lidocaine), and 1C (propafenone)), potassium channel (Class 3 (amiodarone)), and calcium channel (Class 4 (verapamil)) blockers to ^-adrenoceptor blockers (Class 2 (metoprolol)) they all share the common property of being stabilizers of cardiac function and, therefore, are cardiac depressants. Agents in each class have serious side effects associated with their use that makes the decision to employ antiarrhythmic agents very delicate. This particular area of pharmacological management of CVD provides an opportunity to develop novel and useful agents as the current drugs employed to manage arrhythmias are not very satisfactory.

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