Heart failure antiarrhythmic drugs

Ideally, if symptomatic sinus node dysfunction occurs in the presence of drugs known to impair sinus node function, the first treatment is to discontinue the offending drug [29]. However, this is typically not feasible in patients with heart failure who are dependent on several medications to improve long-term outcomes, or may need antiarrhythmic drug therapy for symptomatic arrhythmias. Accordingly, the treatment usually becomes a question of whether to apply pacing to increase heart rate. This is further complicated by the appropriate pacemaker prescription once the decision to pace has been made. 

As with other antiarrhythmic drugs, moricizine has proarrhythmic activity, which may manifest as new ventricular ectopic beats or a worsening of preexisting ventricular arrhythmias. These effects are most common in patients with depressed left ventricular function and a history of congestive heart failure. Cardiovascular ef-... 

Disopyramide (Norpace and Norpace OR) Of all antiarrhythmic drugs, this is the most potent negative inotrope and therefore may induce heart failure in elderly patients. It is also strongly anticholinergic. Other antiarrhythmic drugs should be used. High... 

Chronic heart failure is typically managed by reduction in physical activity, low dietary intake of sodium (less than 1500 mg sodium per day), and treatment with vasodilators, diuretics and inotropic agents. Drugs that may precipitate or exacerbate CHF—nonsteroidal antiinflammatory drugs (NSAIDs), alcohol, (3-blockers, calcium channel-blockers and some antiarrhythmic drugs—should be avoided if possible. Patients with CHF complain of dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, fatigue, and dependent edema. 

Northridge D 1996 Frusemide or nitrates for acute heart failure [see comments] Lancet 347 667-668 Peters N S et al 2002 Atrial fibrillation strategies to control, combat and cure. Lancet 359 593-603 Pitt B et al 2000 Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure randomised trial — the Losartan Heart Failure Survival Study ELITE II. [see comments] Lancet 355 1582-1587 Podrid P J 1999 Redefining the role of antiarrhythmic drugs. New England Journal of Medicine 340 1910-1912... 

Hammermeister KE. Adverse hemodynamic effects of antiarrhythmic drugs in congestive heart failure. Circulation 1990 81(3) 1151-3. 

FIGURE 17-6. Algorithm for the treatment of atrial fibrillation and atrial flutter. Sx = symptoms AVN = AV node DCC = direct-current cardioversion CCB = calcium channel antagonist (verapamil or diltiazem) BB = jS-blocker ASA = aspirin OHD = organic heart disease AADs = antiarrhythmic drugs INR = international normalized ratio MVD = mitral valve disease CHF = congestive heart failure HTN = hypertension DM = diabetes mellitus. 

Labetalol and carvedilol a and P blockers (see drugs in heart failure) Sotalol K+ channel blocker and P blocker (see antiarrhythmics)... 

These results certainly contra-indicate 5-HT4 agonist inotropic agents in patients with heart failure. However, 5-HT4-R-induced tachycardia encourages the search for 5-HT4-R antagonists as antiarrhythmic therapeutic drugs [139]. 

Specific antiarrhythmic drug therapy has been advocated for patients who are at high risk for arrhythmic death, SCD, and total mortality, as standard therapies mentioned are limited in their ability to reduce total mortality in high-risk populations. Several randomized, multicenter antiarrhythmic drug trials have been completed (116-124). Antiarrhythmic drugs used in the post myocardial infarction period or in association with congestive heart failure have not been shown to provide benefit. They may also cause harm. 

In those randomized to an ICD, 93% had a nonthoracotomy lead system, 5% had an epicardial system, and 2% had no device implanted. In those randomized to drug therapy, 356 immediately began empiric therapy with amiodarone. These patients were not considered candidates for sotalol becanse of concern about heart failure, a low ejection fraction, or both. Antiarrhythmic drug therapy was assigned to the remaining 153 patients randomized to drug therapy 79 to amiodarone and 74 to sotalol. In 53 of the 74 patients assigned to... 

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