Ventricular proarrhythmia |
• Torsade de pointes (Vaughan Williams class IA and type III drugs) |
• Sustained monomorphic ventricular tachycardia (usually class IC drugs) |
• Sustained polymorphic ventricular tachycardia/ventricular fibrillation without long QT interval (class IA, IC, and III drugs) |
Atrial proarrhythmia |
• Provocation of recurrence (probably class IA, IC, and III drugs) |
• Conversion of atrial fibrillation (AF) to atrial flutter (usually class IC drugs) with 1:1 conduction |
• Increase of defibrillation threshold (a potential problem with class IC drugs) |
Abnormalities of conduction or impulse formation |
• Accelerate ventricular rate during AF (class IA and type IC drugs) |
• Accelerate conduction over accessory pathway (digoxin, type IV drugs) |
• Sinus node dysfunction, atrioventricular block (almost all drugs) |
Vaughan Williams classification of AADs used for the treatment of atrial fibrillation or flutter |
Class IA - Disopyramide, procainamide, quinidine |
Class IC - Flecainide, propafenone |
Class III - Amiodarone, dofetilide, ibutilide, sotalol |
Class IV - Nondihydropyridine calcium channel blockers (diltiazem and verapamil) |
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