Antiarrhythmic agents: evolution and usability in the cardiac intensive care
Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
The incidence of arrhythmias is increasing in paralel with age and the number of underlying diseases of the patients. Arrhythmias may aggarvate the risk of further morbidity and mortality. The occurence and potentially fatal outcome urges the development of antiarrhythmic agents. Intensive or high dependency care is indicated by primary arrhythmia in a lower ratio of the cases, though a relatively high percentage of the patients treated in the intensive care unit due to their undelying diseases develop secondary arrhythmias. The fundamentals of antiarrhythmic drug treatment is to reveal the etiology and arrhythmia mechanisms. Patients with de novo arrhythmia should be investigated to find structural etiology and precipitating factors. Before drug treatment one should know the basic electrophysiological properties of cardiac cells, patomechanism of arrhythmias and pharmacology. This manuscript gives an overview on the historical milestones of the development of antiarrhythmic agents. Most of these drugs are not in use any more or contradicted due to the cardiovascular, proarrhythmic and non-cardiac side effects. In the present the most effective antiarrhythmics to treat both supravetricular and ventricular arrhythmias in the intensive care are beta-receptor blockers and amiodarone.