Clinical considerations in choosing an antiarrhythmic agent

D. P. Zipes

Research output: Contribution to journalArticle


Classification and pathophysiology of arrhythmias, principles of drug selection, methods for monitoring drug efficacy, and risk of proarrhythmic events are reviewed. The need for drug therapy is influenced by the arrhythmia type. Treatment is most important for life-threatening arrhythmias; infrequently occurring, non-life-threatening arrhythmias generally do not require drug therapy. In general, drug effects are not predictable for patients with ventricular tachyarrhythmias, and drug classifications are of limited value in selecting an antiarrhythmic agent. However, many of the supraventricular tachycardias are exceptions to this rule. Because drug selection is mainly empiric, a drug's adverse-effect profile and proarrhythmic potential are important considerations. The four most commonly used methods for assessing drug efficacy are serial long-term electrocardiography, serial exercise testing, electrophysiologic-pharmacologic testing, and measurement of plasma drug concentrations. Because of the uncertain relationship between plasma drug concentration and efficacy, combined electrocardiographic and electrophysiologic-pharmacologic testing usually is preferred. Determination of the need for drug therapy, selection of the correct antiarrhythmic agent, and documentation of sustained efficacy are required for making appropriate decisions about antiarrhythmic therapy.

Original languageEnglish (US)
Pages (from-to)1-5
Number of pages5
JournalClinical Pharmacy
Issue number3 II
StatePublished - Jan 1 1987

ASJC Scopus subject areas

  • Pharmaceutical Science

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