Cardiovascular Pharmacology: Open Access

Abstract

Antiarrhythmic Medications for Cardioversion and Maintenance of Sinus Rhythm in Patients with Cardiac Arrhythmias: A Review of the Literature

Guhl EN and Jain SK

Introduction: Cardiac arrhythmias, including supraventricular and ventricular tachycardias, portend a higher risk of morbidity and mortality. These arrhythmias also are associated with increased healthcare resource utilization, decreased quality of life, and increased activity impairment. A pharmacologic conversion is a treatment option for conversion to sinus rhythm that has the advantage of avoiding sedation from DC cardioversion.

Objective: To review the efficacy, side effects, clearance, and prescribing considerations for antiarrhythmic medications for pharmacologic cardioversion.

Methodology: We included studies evaluating the efficacy of antiarrhythmic drugs. We included prescribing indications including half-life, clearance, and side effects. We arranged the manuscript by Vaughan Williams classification.

Results: Class IA, class IC, and class III antiarrhythmic medications are effective at the conversion of supraventricular arrhythmias with rates frequently greater than 50%. Amiodarone and Lidocaine may be used for conversion of ventricular tachycardias. The specific agent utilized depends upon the potential other medication interactions, clearance and toxicity.

Conclusion: Pharmacologic cardioversion provides a reasonable alternative to electrical cardioversion in many cases.