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 can be considered as part of a therapeutic strategy to prevent sudden cardiac death. Over 50% of heart failure patients will have asymptomatic non-sustained ventricular tachycardia (NSVT) and it is generally not recommended that NSVT be treated.

Antiarrhythmic Drugs

There are multiple causes of 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

The metabolism 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.

2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure (DO NOT EDIT)

Antiarrhythmics in Patients Presenting With Heart Failure (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current or prior symptoms of heart failure and reduced left ventricular ejection fraction (LVEF) should be avoided or withdrawn whenever possible (e.g., nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and most calcium channel blocking drugs.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) "

Class IIa

1. Ivabradine can be beneficial to reduce HF hospitalization for patients with symptomatic (NYHA class II-III) stable chronic HFrEF (LVEF ≤ 35%) who are receiving GDEM, including a beta blocker at maximum tolerated dose, and who are in sinus rhythm with a heart rate of 70 bpm or greater at rest. (Class IIa, Level of Evidence: B-R)

Vote on and Suggest Revisions to the Current Guidelines

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

External Links

• 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