Congestive heart failure antiarrhythmic drugs

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Antiarrhythmic therapy should be considered as a therapy to prevent sudden cardiac death. Over 50% of heart failure patients will have asymptomatic non-sustained ventricular tachycardia and there is no general indication for treatment of this arrhythmia. T here are multiple causes of the for sudden cardiac death in the patient with congestive heart failure which include not only arrhythmic causes, but also thrombotic and other causes:

• Arrhythmic causes

  Ventricular tachycardia

  Ventricular fibrillation

  Bradyarrhythmias

• Thrombotic causes:

  Acute MI

  Pulmonary embolism

• Other causes:

  Hyperkalemia

Metabolism of Antiarrhythmics in the setting of Congestive Heart Failure

Metabolisms of following anti-arrhythmic drugs are significantly affected in patients with congestive heart failure and care should be taken regarding their administration:

1. Quinidine
2. Procainamide
3. Disopyramide: Contraindicated in patients with heart failure.
4. Moricizine
5. Lidocaine
6. Mexiletine
7. Tocainide
8. Flecainide
9. Propafenone
10. Amiodarone

Patients with congestive heart failure should not be treated with dronedarone.

References

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