Antiarrhytmics

Treatable antiarrhytmics: Atrial fibrillation, Atrial Flutter, Vtach and PSVT

Drugs MOA Indication S/E Notes

Class Ia Fast sodium channel Afib Risk for torsades de Disopyrmaide,
blockers that affect A flutter pointe Quinidine,
phase 0 (depolarization) PSVT Pocainamide
Vtach Procainamide- lupus like
Slows conduction syndrome “Double Quarter
velocity Pounder”
Quinidine- cinchonism
Prolongs action potential (headaches, tinnitus,
duration altered mental status)
Prolongs refractory
period (QT interval)

Class Ib Fast sodium channel Helps stabilize Local anesthetic toxicity Lidocaine,
blockers that affect VTach in situations (CNS symptoms: Mexiletine,
phase 0 (depolarization) where heart is confusion, seizure) Tocainide
diseased or
Shorten action potential ischemic
duration but “Lettuce, Mayo,
preferentially binds to Tomato”
ischemic or abnormal
cells
Class Ic Fast sodium channel Supraventricular Contraindicated in Encainide,
blockers that affect tachycardia patients with heart Moracizine,
phase 0 (depolarization) disease dues to Flecainide,
proarrhytmic effect in Propafenone
Do not change action these patients
potential duration but “Eat More Fries
bids to Na channels most Please”
avidly, especially AV node
Class II Beta blockers; beta PSVT Heart block
adrenergic antagonists Afib Impotence
Aflutter Bradycardia
Stop sympathetic activity Bronchospasm
on the heart sedation

Decrease HR and AV
nodal conduction velocity
(increased PR interval on
ECG)
Class III Potassium channel Torsades de pointes Amiodarone (Class I
blockers that affect to IV activity),
phase 3 (repolarization) Amiodarone: Bretylium,
Photosensitivity Dofetilide, Ibutilide,
Prolongs action potential Pulmonary fibrosis Sotalol (beta
Prolongs refractory (check PFTs) blocker but is Class
period Thyroid function (iodine III)
in drug causes thyroid
abnormalities) and “A Big Dog Is Scary”
hepatotoxicity (check
LFTs)

Class IV L-type Calcium Channel PVST Edema Verapamil,

Blockers Heart block diltiazem
Constipation
Decrease conduction Flushing
velocity and heart rate

Decrease rapidity of SA
node depolarization