Supraventricular and ventricular arrhythmia

Procainamide. Procainamide hydrochloride is a ben2amide, synthesized to prolong the therapeutic effects of the local anesthetic procaine [59-46-1] (13) (see Anesthetics). The dmg is effective in a wide range of supraventricular and ventricular arrhythmias (14). 

Fleca.inide, Elecainide acetate, a fluorobenzamide, is a derivative of procainamide, and has been reported to be efficacious in suppressing both supraventricular and ventricular arrhythmias (26—29). The dmg is generally reserved for patients with serious and life-threatening ventricular arrhythmias. Elecainide depresses phase 0 depolarization of the action potential, slows conduction throughout the heart, and significantly prolongs repolarization (30). The latter effect indicates flecainide may possess some Class III antiarrhythmic-type properties (31). 

The most frequently used classification system is that proposed by Vaughan Williams (Table 6-1). Type la drugs slow conduction velocity, prolong refractoriness, and decrease the automatic properties of sodium-dependent (normal and diseased) conduction tissue. Type la drugs are broad-spectrum antiarrhythmics, being effective for both supraventricular and ventricular arrhythmias. 

Amiodarone is useful in the treatment of supraventricular and ventricular arrhythmias. Amiodarone tends to hove a number of side-effects, such os photosensitivity. Patients ore advised to ovoid exposure to sunlight and apply a sun protection factor on a doily basis. Amiodarone may also cause reversible corneal microdeposits os a result of v/hich patients find night glare irritating and so patients ore advised to ovoid driving at night. 

Amiodarone is an anti-arrhythmic drug indicated in supraventricular and ventricular arrhythmias. One of the main side-effects is photosensitivity and patients are advised to avoid exposure to sunlight and use sun protection factors. 

Propranolol slows heart rate, increases the effective refractory period of atrioventricular ganglia, suppresses automatism of heart cells, and reduces excitability and contractibihty of the myocardium. It is used for supraventricular and ventricular arrhythmias. Synonyms of this drug are anaprilin, detensiel, inderal, novapranol, and others. 

Based on several studies flecainide appears to be beneficial in treating supraventricular and ventricular arrhythmias in children. Elimination half-life is shorter and volume of distribution is smaller. 

Phenytoin finds its most effective use in the treatment of supraventricular and ventricular arrhythmias associated with digitalis intoxication. The ability of phenytoin to improve digitaUs-induced depression of A-V conduction is a special feature that contrasts with the actions of other antiarrhythmic agents. 

Mechanism of Action An antiarrhythmicthat slows atrial, AV, His-Purkinje, and intraventricular conduction. Decreases excitability conduction velocity and automaticity. Therapeutic Effect Controls atrial, supraventricular, and ventricular arrhythmias. Pharmacokinetics Almost completely absorbed following PO administration. Protein binding 40%. Metabolized in liver. Excreted in urine. Half-life 19-22 hr. 

Supraventricular and ventricular arrhythmias (12%), nonsustained ventricular tachycardia (2%), and sustained ventricular tachycardia (1%) may occur. 

Hypotension, angina pectoris, supraventricular and ventricular arrhythmias. 

Ventricular tachycardia, atrial fibrillation, and flutter (can convert recent-onset fibrillation or flutter to sinus rhythm). Amiodarone is used in the management of patients with supraventricular and ventricular arrhythmias, and arrhythmias associated with the WPW syndrome... 

Sotalol is approved for the treatment of life-threatening ventricular arrhythmias and the maintenance of sinus rhythm in patients with atrial fibrillation. It is also approved for treatment of supraventricular and ventricular arrhythmias in the pediatric age group. Sotalol decreases the threshold for cardiac defibrillation. 

Beta antagonists are effective in the treatment of both supraventricular and ventricular arrhythmias (see Chapter 14 Agents Used in Cardiac Arrhythmias). It has been suggested that the improved... 

Disopyramide has been used in treating both the supraventricular and ventricular arrhythmias occurring in patients with HCM. In addition, the negative inotropic effect and the ability to increase peripheral vascular resistance attributed to disopyramide have been used to reduce... 

Propranolol, a noncardioselective beta-adrenoreceptor blocker (80 to 480 mg/day p.o.) is approved for more indications than any other beta-adrenergic-receptor-blocking drug. The three major areas of use in cardiovascular medicine are the management of CAD, the treatment of hypertension, and the treatment and prophylaxis of supraventricular and ventricular arrhythmias. In addition, propranolol has many other uses and has had a major impact on areas of medicine remote from cardiology and hypertension (see Figures 69, 70, and 83). 

P Receptor antagonists are used extensively in the treatment of hypertension (see Chapter 32), angina and acute coronary syndromes (see Chapter 31), and congestive heart failure (see Chapter 33). These drugs also are used frequently in the treatment of supraventricular and ventricular arrhythmias (see Chapter 34). 

Amiodarone is a Type III antiarrhythmic agent. It has been shown in several clinical trials to be safe and effective in the treatment of supraventricular and ventricular arrhythmias in patients with cardiovascular disease. Amiodarone is also associated with fewer proarrhythmic effects compared with other antiarrhythmic drugs. Amiodarone is empirically dosed and adjusted based on efficacy and toxicity. 

Procainamide is a Type la antiarrhythmic agent used to treat supraventricular and ventricular arrhythmias. This drug is also used in the management of cardiac arrest. ... 

Quinidine, procainamide (Pronestyl ), and disopyramide (Notpace ) at type laan-tlarrhythmlc agents. Quinidine and procainamide are commonly used for suppression of supraventricular and ventricular arrhythmias. Disopyramide is used for ventricular arrhythmias. All three agents have a low toxic therapeutic ratio and may produce fatal intoxication (Table 11-49). See description of other antianhythmic agents on p 78. 

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