A benefit-risk assessment of class III antiarrhythmic agents.
The prevalence of arrhythmia in the population is increasing as more people survive for longer with cardiovascular disease. It was once thought that antiarrhythmic therapy could save life, however, it is now evident that antiarrhythmic therapy should be administrated with the purpose of symptomatic relief. Since many patients experience a decrease in physical performance as well as a diminished quality of life during arrhythmia there is still a need for antiarrhythmic drug therapy. The development of new antiarrhythmic agents has changed the focus from class I to class III agents since it became evident that with class I drug therapy the prevalence of mortality is considerably higher. This review focuses on the benefits and risks of known and newer class III antiarrhythmic agents. The benefits discussed include the ability to maintain sinus rhythm in persistent atrial fibrillation patients, and reducing the need for implantable cardioverter defibrillator shock/antitachycardia therapy, since no class III antiarrhythmic agents have proven survival benefit. The risks discussed mainly focus on pro-arrhythmia as torsade de pointes ventricular tachycardia.
Elming
Hanne
H
Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark. he@heart.dk
Brendorp
Bente
B
Pehrson
Steen
S
Pedersen
Ole Dyg
OD
Køber
Lars
L
Torp-Petersen
Christian
C
D000638:Amiodarone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000145:classification / Q000494:pharmacology / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable; D000077764:Dronedarone; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D006827:Hydantoins; D048289:Imidazolidines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D017136:Ion Transport / Q000187:drug effects; D015993:Life Tables; D008564:Membrane Potentials / Q000187:drug effects; D015201:Meta-Analysis as Topic; D010627:Phenethylamines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D010879:Piperazines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D018570:Risk Assessment; D013015:Sotalol / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D013449:Sulfonamides / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D016019:Survival Analysis; D016171:Torsades de Pointes / Q000139:chemically induced; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D006827:Hydantoins; D048289:Imidazolidines; D010627:Phenethylamines; D010879:Piperazines; D013449:Sulfonamides; C067192:ibutilide; C086123:azimilide; D013015:Sotalol; D000077764:Dronedarone; D000638:Amiodarone; C063533:dofetilide