Non-investigational antiarrhythmic drugs: long-term use and limitations

Long-term use of antiarrhythmic drugs is less important today as curative catheter ablation often is more appropriate, and the use of implantable cardioverter-defibrillators is an option. Many patients, however, still prefer, or are merely offered drug treatment.

To review current literature on conventional antiarrhythmic drugs in the intervention and device era, with focus on efficacy, side effects, drug interactions and pro arrhythmic problems in adult patients.

Antiarrhythmic drugs are still justified in patients who prefer this treatment or who cannot be cured by catheter ablation owing to technical problems or lack of treatment capacity. Another main use of these drugs is adjunctive treatment after unsuccessful catheter ablation or when arrhythmias frequently recur in a patient with an implanted device. Drug interactions owing to treatment for comorbidity represent a serious challenge.