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Updated: Jul 26, 2026

Isolation of Human Atrial Myocytes for Simultaneous Measurements of Ca2+ Transients and Membrane Currents
Published on: July 3, 2013
[New anti-arrhythmia agents]
1Institut für Pharmakologie und Toxikologie, Technischen Universität München.
Insights
Class-I antiarrhythmic drugs increase mortality in post-myocardial infarction patients and should be avoided. Other antiarrhythmic agents show potential but require further clinical trials for safety and efficacy in cardiac arrhythmias.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Class-I antiarrhythmic agents (encainide, flecainide, moricizine) are used for ventricular premature depolarizations.
- Symptomatic tachyarrhythmias require careful risk-benefit assessment for class-I agents.
- New class-I drug development appears unpromising.
Purpose of the Study:
- Evaluate the efficacy and safety of antiarrhythmic agents.
- Assess the impact of antiarrhythmic drugs on mortality after myocardial infarction.
- Explore potential treatments for supraventricular and ventricular arrhythmias.
Main Methods:
- Review of clinical trials and pharmacological profiles of antiarrhythmic drugs.
- Analysis of mortality data in post-myocardial infarction patients treated with class-I agents.
- Preclinical and clinical evaluation of class-III antiarrhythmic agents.
Main Results:
- Class-I agents increase mortality in asymptomatic post-myocardial infarction patients.
- Esmolol is an effective intravenous beta-blocker for supraventricular arrhythmias.
- Class-III agents (sematilide, dofetilide) show preclinical efficacy but require clinical validation; torsades de pointes is a risk.
Conclusions:
- Avoid class-I antiarrhythmics in asymptomatic post-MI patients.
- Amiodarone and sotalol show promise for improving survival in patients at risk of sudden cardiac death.
- Further controlled trials are needed to establish the clinical value of new antiarrhythmic agents.
Abstract:
Use of class-I antiarrhythmic agents (encainide, flecainide or moricizine) to suppress asymptomatic ventricular premature depolarizations does not decrease, but rather increases mortality from cardiac events after myocardial infarction. These patients should not be treated with antiarrhythmic drugs until improved survival is shown in a controlled clinical trial. In other clinical conditions such as symptomatic tachyarrhythmias class-I agents should only be used if the expected benefit outweighs the risk of an adverse cardiac effect. The development of new class-I drugs does not seem promising. Esmolol is the first intravenous and ultrashort-acting beta-adrenoceptor blocker that can be used to treat supraventricular arrhythmias in the critical care setting; in addition, it displays high cardioselectivity. Specific class-III antiarrhythmic agents including sematilide and dofetilide have been shown to be effective against ventricular tachyarrythmias in preclinical studies, but their clinical value remains to be established. Torsades de pointes arrhythmia is an undesirable side-effect closely coupled to specific class-III action that may limit their future use. The known pharmacological profiles and limited controlled clinical studies make amiodarone and sotalol promising candidates for drugs that may improve survival of patients at risk for sudden cardiac death.
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