Antiarrhythmic drug therapy. Recent advances and current status.
A number of conventional and newer antiarrhythmic agents are available for the treatment and prophylaxis of ventricular tachycardia and sudden death. Using a multifaceted approach of programmed electrical stimulation studies, drug level determinations, exercise tolerance testing, and 24-hour ambulatory electrocardiographic monitoring, the physician can identify those patients who require therapy and then predict the likelihood of efficacy with each antiarrhythmic agent. This approach affords evaluation of both aspects of the sudden death equation-ectopy frequency (triggering mechanism) and vulnerability to development of sustained ventricular tachycardia (substrate). After institution of therapy, careful follow-up is necessary to document sustained drug efficacy and detect side effects. Serious adverse reactions necessitate a change in antiarrhythmic therapy, as opposed to lowering drug dosage to an ineffective level. The unacceptably high incidence of sudden death due to electrical instability can be reversed only by a rigorous and dedicated long-term approach to the management of serious ventricular arrhythmias.
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D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000404:Ajmaline / Q000009:adverse effects / Q000627:therapeutic use; D000638:Amiodarone / Q000008:administration & dosage / Q000627:therapeutic use; D000813:Anilides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D001073:Aprindine / Q000009:adverse effects / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D044482:Benzeneacetamides; D015764:Bepridil; D001627:Bethanidine / Q000009:adverse effects / Q000627:therapeutic use; D001950:Bretylium Tosylate / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use; D004206:Disopyramide / Q000009:adverse effects / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use; D004334:Drug Administration Schedule; D016700:Encainide; D005424:Flecainide; D006329:Heart Conduction System / Q000187:drug effects; D006801:Humans; D007093:Imidazoles / Q000378:metabolism / Q000627:therapeutic use; D008012:Lidocaine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000378:metabolism / Q000627:therapeutic use; D008801:Mexiletine / Q000378:metabolism / Q000627:therapeutic use; D016293:Moricizine; D009200:Myocardial Contraction / Q000187:drug effects; D010640:Phenothiazines / Q000627:therapeutic use; D010672:Phenytoin / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use; D010880:Piperidines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D011342:Procainamide / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D011405:Propafenone; D011427:Propiophenones / Q000627:therapeutic use; D011759:Pyrrolidines / Q000009:adverse effects / Q000627:therapeutic use; D011802:Quinidine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D016677:Tocainide; D014700:Verapamil / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000813:Anilides; D000889:Anti-Arrhythmia Agents; D044482:Benzeneacetamides; D007093:Imidazoles; D010640:Phenothiazines; D010880:Piperidines; D011427:Propiophenones; D011759:Pyrrolidines; D000404:Ajmaline; D008801:Mexiletine; D016677:Tocainide; D016293:Moricizine; D001073:Aprindine; D010672:Phenytoin; D011405:Propafenone; D015764:Bepridil; D001950:Bretylium Tosylate; D008012:Lidocaine; D014700:Verapamil; D004206:Disopyramide; D011802:Quinidine; D005424:Flecainide; C015970:lorcainide; D011342:Procainamide; D000638:Amiodarone; D016700:Encainide; C024318:pirmenol; D001627:Bethanidine; C032151:cifenline