Congestive heart failure antiarrhythmic drugs

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

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.

ACC/AHA Guidelines- Patients With Reduced Left Ventricular Ejection Fraction (DO NOT EDIT)

“

Class I 1. Drugs known to adversely affect the clinical status of patients with current or prior symptoms of heart failure and reduced left ventricular ejection fraction (LVEF) should be avoided or withdrawn whenever possible (e.g., nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and most calcium channel blocking drugs. (Level of Evidence: B)

”

Vote on and Suggest Revisions to the Current Guidelines

• The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

• The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

• 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation

References

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