- A group of international societies has released consensus recommendations as a guide to antiarrhythmic drugs (AADs), including guidance for specific patient populations.
- Societies involved in or endorsing the consensus: European Heart Rhythm Association, European Society of Cardiology Working Group on Cardiovascular Pharmacology, Heart Rhythm Society, Asia-Pacific Heart Rhythm Society, and International Society of Cardiovascular Pharmacotherapy.
Why this matters
- Authors note that AADs can involve significant adverse events and say that the classification that most clinicians use to determine therapy has “minimal clinical relevance.”
- Recommendation categories are visually easy to distinguish: a red heart means “Should NOT be used/recommended,” yellow means “May be used/recommended,” green means “Recommended/indicated.”
- Recommendations for decision-making include noting limited indications for current AADs (eg, symptom alleviation, avoiding malignant arrhythmia), cautions (AADs not to be used to avoid oral anticoagulants), and follow-up (eg, ECG scheduling).
- Monitoring should include considering acute and chronic risks separately.
- Individualizing includes recommendations for patients with structural heart disease with/without Afib, renal disease, syncope history, preexisting QRS >130 ms (caution warranted), and pregnancy (options limited, maternal-fetal medicine consult possibly needed).
- Recommendations by type of arrhythmia also included, ie, ventricular arrhythmia with/without structural heart disease, premature atrial beats, supraventricular arrhythmia Afib, atrial flutter, patients with devices.
- Safety issues are key; recommendations address what to watch for (eg, proarrhythmias) and monitoring for thyrotoxicosis.