Antiarrhythmic drug therapy

The use of antiarrhythmic drugs can be challenging to physicians. They are effective in treating various types of arrhythmias, yet their potential to cause adverse events, in particularly proarrhythmia, can be intimidating. When the decision to use antiarrhythmic therapy has been made, physicians are confronted with several issues: choosing the right drug, preventing complications, and selecting the setting in which the drug is to be given (in-hospital vs outpatient). In determining the best antiarrhythmic agent for each patient, one should have a basic understanding of their mechanisms of action and indications. Once this decision has been made, attention turns to avoiding complications and assessing for efficacy. Clinicians should be aware of the common drug interactions of each antiarrhythmic agent and avoid these whenever possible. In addition, patients need meticulous follow-up, including serial electrocardiograms and assessment for cardiovascular side effects. For several of the antiarrhythmic drugs, this can be accomplished in the outpatient setting in appropriate patients.