Non-antiarrhythmic drugs for the prevention of cardiac arrhythmias.
It is noteworthy that drugs having a significant impact in preventing arrhythmias (atrial or ventricular) are those with no direct specific antiarrhythmic electrophysiologic properties. Specifically, drugs able to interfere with the renin-angiotensin system and the n-3 fatty acids seem to play a relevant role as antiarrhythmics, even if they do not act in the typical manner. Angiotensin-converting enzyme (ACE) inhibitors decrease the incidence of arrhythmias in patients with decreased left ventricular function. The main reduction is linked to a decrease of ventricular arrhythmias, while several studies have suggested that ACE-inhibitors may also decrease the burden of atrial fibrillation. Furthermore, many of angiotensin receptor blockers and spironolactone have been shown to have antiarrhythmic properties. n-3 polyunsaturated fatty acids (PUFAs) are known to be antiarrhythmic as well. Their effects on the fast voltage-dependent sodium current I(NA), inhibition of I(Ca2+) and the K+ channel modulation explain their antiarrhythmic properties. For these reasons the renin-angiotensin system blockade and the n-3 PUFA intake may provide simple and safe protection from cardiac arrhythmias.
Di Biase
Matteo
M
Cardiology Department, University of Foggia, Foggia, Italy. dibiama@tiscali.it
Troccoli
Rossella
R
Brunetti
Natale Daniele
ND
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D011945:Receptors, Angiotensin / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D015525:Fatty Acids, Omega-3; D000451:Mineralocorticoid Receptor Antagonists; D011945:Receptors, Angiotensin