Negative inotropic effects of antiarrhythmic drugs: a clinical point of view

From a clinical point of view, the negative inotropic effects of antiarrhythmic drugs lead to the following questions: Do antiarrhythmic drugs induce or worsen congestive heart failure (CHF)? Which patients are at increased risk of developing CHF with antiarrhythmic drugs? Which antiarrhythmic drugs are most likely to induce CHF clinically? The present review of the recent literature demonstrates that antiarrhythmic drugs may induce or worsen CHF in a small number of patients. This is true for all antiarrhythmic drugs, but only disopyramide (and flecainide) are antiarrhythmic drugs with a relevant rate of clinical CHF. Patients with a history of heart failure, a low left ventricular ejection fraction, and cardiomyopathy are at increased risk of developing CHF with antiarrhythmic drugs, especially if the drugs are administered intravenously and in high doses.