Antiarrhythmic and Anticoagulant Agents

Abstract

For effective management of cardiac arrhythmias, it is critical that clinicians have not only a knowledge of the mechanism underlying rhythm disorders but a foundational knowledge of the therapeutic tools for management, including pharmacotherapy. Table 7.1 provides a general overview of common antiarrhythmic agents, mechanism of action, basic pharmacokinetics, adverse effects, and monitoring recommendations. In addition to familiarity with the agents, clinicians should be aware of how to find more information about each agent including drug references, guidelines, and primary literature. Antiarrhythmic agents are associated with adverse events that can limit treatment. It is necessary to select an agent that is effective but also minimizes harm. Furthermore, clear patient education regarding risks vs. benefits should be completed when starting antiarrhythmic therapy.

Later in the EP sections, pharmacologic management of various disease states will be outlined along with the preferred agents used for each disorder. It should be noted that some agents in the table may not be used frequently in current practice but are listed in case the drug is encountered. It is important that clinicians stay abreast to changes in the field and updates in the most recent guidelines.

Anticoagulation Therapy

As outlined in the atrial fibrillation section (Chap. 9), one of the core goals in management is to prevent or reduce the risk of stroke and systemic embolism. The preferred strategy to decrease risk is systemic anticoagulation. The Atrial Arrhythmia chapter will provide the recommendations of when and to whom anticoagulation therapy should be prescribed. However, as with the antiarrhythmic agents, it is important to select the agent that optimizes efficacy and reduces risk of bleeding. Decisions should be made based on patient factors including renal function, liver function, weight, age, ability to adhere to regimen, cost, and other factors. In addition, the patient should have education provided about their anticoagulation at each encounter including benefits and risks (Tables 7.1 and 7.2).

Table 7.1 Antiarrhythmic agents

Table 7.2 Oral anticoagulants used in stroke prevention for AF