[New developments in the antiarrhythmic therapy of atrial fibrillation].
Atrial fibrillation, which is associated with a worsening of congestive heart failure symptoms, an increased rate of stoke, and increased mortality, is still difficult to treat. New therapies must not only increase effectiveness, but also have to have an improved safety profile, in order to avoid sodium channel block in the ventricle of older patients with atrial fibrillation, and also prevent electrical and morphological remodeling. Dronedarone is less effective compared to amiodarone, but has a better side effect profile which leads to fewer discontinuations of treatment. The atrial ion channels are specifically blocked by a number of prospective antiarrhythmic substances. The most advanced is the testing of vernakalant (RSD1235), which primarily suppresses the I(Kur) current. Ranolazine is a new antianginal substance which influences the atrial ion channels and leads to a significant reduction of atrial and more specifically ventricular tachyarrhythmias. A number of other drugs are in development. They will lead to a better understanding of which form of atrial fibrillation can be best treated with which antiarrhythmic agent.
Kardiopulmonales Zentrum, Klinikum Coburg, Ketschendorferstr. 33, 96450, Coburg, Deutschland. simon.helge@gmail.com
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Simon
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Simon Demel
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Ritscher
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Turschner
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Brachmann
D000083:Acetanilides / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000638:Amiodarone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000818:Animals; D000840:Anisoles / Q000009:adverse effects / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D000077764:Dronedarone; D064420:Drug-Related Side Effects and Adverse Reactions; D015507:Drugs, Investigational / Q000009:adverse effects / Q000627:therapeutic use; D004562:Electrocardiography / Q000187:drug effects; D006325:Heart Atria / Q000187:drug effects; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control; D006352:Heart Ventricles / Q000187:drug effects; D006801:Humans; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use; D015221:Potassium Channels / Q000187:drug effects; D011759:Pyrrolidines / Q000009:adverse effects / Q000627:therapeutic use; D000069458:Ranolazine; D015222:Sodium Channels / Q000187:drug effects; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
D000083:Acetanilides; D000840:Anisoles; D000889:Anti-Arrhythmia Agents; D015507:Drugs, Investigational; D010879:Piperazines; D015221:Potassium Channels; D011759:Pyrrolidines; D015222:Sodium Channels; C524581:vernakalant; D000069458:Ranolazine; D000077764:Dronedarone; D000638:Amiodarone