Anti-arrhythmic drugs

The management of ventricular and other serious cardiac arrhythmias is best undertaken with specialist cardiological guidance.

For permanent atrial fibrillation, beta-blockers, eg bisoprolol (Beta-adrenoceptor blocking drugs) are useful agents for rate control.  If contra-indications exist rate limiting calcium-channel blockers eg verapamil, diltiazem [off-label] (Nitrates, calcium-channel blockers and other antianginal drugs) or digoxin (Cardiac glycosides) may be considered.

For paroxysmal atrial fibrillation/supraventricular tachycardias, beta-blockers, eg bisoprolol, are useful first choice agents to prevent paroxysms.  Second-line drugs may be used but are limited by adverse and pro-arrhythmic effects; they include flecainide, propafenone, amiodarone and sotalol.  Due to potential pro-arrhythmia effects, all require hospital specialist guidance. Digoxin is less useful in these situations providing little preventative effect during paroxysms. Note NICE CG180 ‘Atrial fibrillation: management’.  

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