Proarrhythmic effects of antiarrhythmic and non-antiarrhythmic drugs

Many drugs, including both antiarrhythmic and non-antiarrhythmic medications, affect the ion channels and receptors of the heart with the potential to produce a proarrhythmic action. The proarrhythmic action of these drugs is influenced by electrolyte disturbances, hemodynamic abnormalities, and conditions affecting the metabolism and excretion of the medication. This chapter will discuss the mechanisms of proarrhythmic states commonly encountered, illustrate characteristic scenarios, and explain treatment strategies for medication-induced proarrhythmic states. As it is often difficult clinically to differentiate between arrhythmias occurring at therapeutic medication concentrations and those occurring at toxic levels, the treatment of antiarrhythmic toxicity is also discussed.