Advances in the pharmacologic treatment of ventricular arrhythmias

J. William Schleifer, Dan Sorajja, Win Kuang Shen

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction: Despite many advances in nonpharmacologic management of ventricular arrhythmias, antiarrhythmic drugs remain important in both the acute conversion and chronic prevention of ventricular arrhythmias.Areas covered: Key trials related to antiarrhythmic drug use are reviewed, emphasizing the impact of recent discoveries. Sodium channel blockers are discussed with an emphasis on recently identified specialized uses. Beta blockers, amiodarone, sotalol, and dofetilide are discussed together in the context of structural heart disease, because they do not increase mortality in this group of patients. Other medications found to reduce ventricular arrhythmia burden are discussed last.Expert opinion: Since most patients with ventricular arrhythmias have structural heart disease, pharmacologic treatment is limited to amiodarone, d-,l-sotalol, and dofetilide (off-label indication), in conjunction with defibrillator implantation. While amiodarone has superior reduction in arrhythmias, its long-term extracardiac toxicities can cause significant morbidity. A trial of sotalol is reasonable if there are no contraindications, recognizing that over 20% of patients have to discontinue it because of adverse effects. Beta blockers are first line therapy for most patients. Genetic testing is particularly informative regarding treatment approach in long QT syndrome, Brugada syndrome, and catecholaminergic polymorphic VT. Research should continue to focus on developing more effective antiarrhythmic medications with less long-term toxicity.

Original languageEnglish (US)
Pages (from-to)2637-2651
Number of pages15
JournalExpert Opinion on Pharmacotherapy
Volume16
Issue number17
DOIs
StatePublished - Nov 22 2015

Fingerprint

Cardiac Arrhythmias
Sotalol
Amiodarone
Anti-Arrhythmia Agents
Heart Diseases
Sodium Channel Blockers
Brugada Syndrome
Therapeutics
Long QT Syndrome
Defibrillators
Expert Testimony
Genetic Testing
Morbidity
Mortality
Research
dofetilide

Keywords

  • amiodarone
  • antiarrhythmic drugs
  • beta blockers
  • ventricular fibrillation
  • ventricular tachycardia

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology

Cite this

Advances in the pharmacologic treatment of ventricular arrhythmias. / Schleifer, J. William; Sorajja, Dan; Shen, Win Kuang.

In: Expert Opinion on Pharmacotherapy, Vol. 16, No. 17, 22.11.2015, p. 2637-2651.

Research output: Contribution to journalArticle

Schleifer, J. William ; Sorajja, Dan ; Shen, Win Kuang. / Advances in the pharmacologic treatment of ventricular arrhythmias. In: Expert Opinion on Pharmacotherapy. 2015 ; Vol. 16, No. 17. pp. 2637-2651.
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