Antiarrhythmic drugs. Antiarrhythmic drug with anesthetic properties

Arrhythmic conditions of pathological etiology require specialized medical treatment. All antiarrhythmic drugs are prescribed by a cardiologist - self-medication is strictly prohibited.

Antiarrhythmic drugs

They are prescribed to patients after passing a full diagnostic examination, making a final diagnosis of the pathological nature of arrhythmic problems. Conditions can threaten and interfere with the full life of the patient.

Medicines have a positive effect on the body - the normalization of the rhythm of contractions allows you to stabilize the work of the circulatory department, with the timely delivery of oxygen and nutrients to the tissues of the internal organs. Medications ensure the full functioning of all internal systems.

Antiarrhythmic drugs require monitoring by medical professionals - their effects are constantly monitored by an electrocardiogram procedure, at least once every 20 days (the course of therapy is usually quite long).

Upon admission to the cardiology department, the patient is prescribed intravenous or oral medication. If the desired positive effect is not recorded, then the patient is recommended to conduct an electrical type of cardioversion.

In the absence of chronic pathologies of the cardiovascular department, the patient may be shown outpatient treatment - with periodic consultations of a cardiologist. If attacks of arrhythmia are rare and short-lived, then the patient is transferred to dynamic observation.

The principle of action of these medicines

Antiarrhythmic drugs have a positive effect:

• to lower the level of excitability of the organ;
• decrease in the sensitivity of the heart muscle in relation to electrical impulses, with the prevention of the formation of fibrillation;
• reduction of manifestations of accelerated heartbeat;
• suppression of additional impulses;
• shortening the interval of the contractile impulse;
• an increase in the duration of diastole.

Classification

The division of drugs is carried out according to four main classes, depending on the ability of the drug to conduct electrical impulses. There are several forms of arrhythmic deviations, in accordance with which the necessary pharmacological substances are selected.

The main drugs include:

• sodium channel blockers;
• beta blockers;
• potassium antagonists;
• calcium antagonists.

Other forms of medications are represented by cardiac glycosides, tranquilizers, sedatives and neurotropic drugs. They are characterized by a combined effect on the innervation and performance of the heart muscle.

Table: division of antiarrhythmics into classes

Representatives of major groups and their action

The antiarrhythmic effect depends on the subgroup of drugs. Among them are:

1A class

These drugs are necessary for two types of extrasystoles - supraventricular and ventricular, to restore sinus rhythm in atrial fibrillation, in order to prevent its recurrence. Commonly used agents include Quinidine and Novocainamide.

Quinidine- is administered in tablet form. The negative impact on the body when used is represented by:

• dyspeptic disorders - nausea, vomiting, diarrhea;
• sudden attacks of headache.

When taking a pharmacological agent, there is a decrease in the number of platelets in the blood stream, a decrease in the level of contractility of the heart muscle, and a slowdown in the functionality of the conduction system in the heart.

The most dangerous side effects include the formation of a separate ventricular tachycardia, with the possible development of a fatal outcome. The therapy is carried out under the constant supervision of medical personnel and ECG readings.

Quinidine is prohibited for use:

• with blockades of atrioventricular and intraventricular character;
• thrombocytopenia;
• poisoning - with uncontrolled intake of cardiac glycosides;
• insufficient functionality of the heart muscle;
• hypotension - with minimal blood pressure;
• during the childbearing period.

Novocainamide- recommended for use according to the same indicators as the previous drug. It is prescribed to suppress attacks of atrial fibrillation. At the time of intravenous administration of the substance, a sudden drop in blood pressure may occur - therefore, the solution must be used with the utmost care.

The negative effect of the drug is represented by:

• nausea with the transition to vomiting;
• changes in the blood formula;
• collapse;
• violations of the functionality of the nervous system - sudden attacks of headaches, periodic dizziness, changes in the clarity of consciousness.

Continuous uncontrolled use may cause arthritis, serositis or feverish conditions. There is a possibility of the formation of infectious processes in the oral cavity, with the formation of bleeding and delayed healing of ulcers and small wounds.

A pharmacological substance can provoke allergic reactions - the initial symptomatic manifestations of the problem are muscle weakness, which manifests itself when using the drug. The drug is prohibited for use:

• with atrioventricular blockade;
• insufficient functionality of the heart muscle or kidneys;
• in cardiogenic shock conditions;
• hypotension - with extremely low blood pressure.

1B class

These drugs are not effective in detecting supraventricular arrhythmia in a patient - the active ingredients do not have the necessary effect on the sinus node, atrium and atrioventricular junction.

The drugs are used to treat ventricular-type arrhythmic abnormalities - extrasystoles, paroxysmal tachycardias, to treat problems associated with overdose or uncontrolled use of cardiac glycosides.

The main representative of this subgroup is Lidocaine. It is prescribed for severe forms of ventricular disturbances in the rhythm of organ contraction, in the acute phase of myocardial infarction. The drug can cause negative reactions of the body:

• convulsive conditions;
• periodic dizziness;
• decreased visual acuity;
• problems with intelligible speech;
• impaired clarity of consciousness;
• rashes on the skin;
• hives;
• angioedema;
• persistent itching.

Incorrectly calculated dosages can provoke a decrease in the level of contractility of the heart muscle, a slowdown in the speed of contractions, rhythm disturbances - up to arrhythmic deviations.

The pharmacological substance is not recommended for use in atrioventricular blockade, the pathology of the weakening of the sinus node. Severe forms of supraventricular arrhythmic conditions are contraindications - there is a high risk of atrial fibrillation.

1C class

These pharmacological substances are able to lengthen the time of intracardiac conduction. Against the background of pronounced arrhythmogenic efficacy, the drugs received a restriction on their use. The main representative of the subgroup is Ritmonorm.

The drug is necessary to suppress the negative symptomatic manifestations of ventricular or supraventricular arrhythmias. When taken, there is a high risk of the formation of an arrhythmogenic effect, therapy is carried out under the constant supervision of a medical worker.

In addition to arrhythmic pathologies, the drug can provoke disturbances in the contractility of the heart muscle, further development of insufficient functionality of the organ. Pathological abnormalities can manifest themselves:

• nausea;
• vomiting;
• metallic taste in the mouth;
• dizziness;
• decreased visual acuity;
• depressive states;
• night sleep disturbances;
• changes in blood tests.

Grade 2

A large amount of adrenaline produced is recorded with an increase in the functionality of the sympathetic nervous section - in stressful situations, vegetative abnormalities, arterial hypertension, ischemic damage to the heart muscle.

The hormone stimulates the activity of beta-adrenergic receptors in the muscle tissues of the heart - the result is unstable heart function and the formation of arrhythmic abnormalities. The main mechanism of action of these drugs includes the suppression of increased receptor activity. The heart muscle is protected.

In addition to the above positive effects, drugs reduce the automatism and the level of excitability of the cellular elements that make up the conductive department. Under their direct influence, the speed of contractions of the heart muscle slows down. By reducing atrioventricular conduction, medications reduce the frequency of organ contractions at the time of atrial fibrillation.

Drugs are prescribed for the treatment of atrial fibrillation and fibrillation, for the suppression and prophylactic effect of supraventricular arrhythmic conditions. Help with sinus tachycardia.

Ventricular forms of the pathological process are less susceptible to the influence of beta-blockers - the exception is a disease that is directly related to an excess of hormones in the bloodstream. As the main means of treatment, the use of Anaprilin and Metoprolol is recommended.

The negative impact of the above medications includes a decrease in the level of contractility of muscle tissues, a slowdown in the rate of heart contractions, and the formation of atrioventricular blockade. Pharmacological substances can significantly disrupt the functionality of the circulatory department, cause a decrease in the temperature of the lower and upper extremities.

The use of Propranolol can provoke a deterioration in bronchial conduction - pathology is dangerous for patients suffering from bronchial asthma. Beta-blockers can worsen the course of diabetes mellitus - when used, there is an increase in glucose in the bloodstream.

Medications can affect the nervous system - provoke spontaneous dizziness, disturbed night sleep, memory loss, cause depressive states. Drugs disrupt the conduction of the neuromuscular department, manifesting itself in the form of increased fatigue, weakness, and a decrease in muscle tone.

In some cases, rashes on the skin, persistent itching and focal alopecia may appear. Erectile dysfunction may occur in males, and thrombocytopenia and agranulocidosis can be observed in blood counts.

Drugs with sudden cancellation cause pathological conditions:

• anginal attacks;
• violations of the rhythm of the heart muscle at the level of the ventricles;
• increase in blood pressure;
• acceleration of the pulse;
• decrease in the level of exercise tolerance.

Cancellation of drugs is carried out in stages, over two weeks. Beta-blockers are prohibited for use with insufficient functionality of the organ, swelling of the lung tissues, cardiogenic shock conditions, and severe cases of chronic heart failure. Also, their appointment is not recommended for diabetes mellitus, sinus type of bradycardia, a drop in systolic pressure below 100 units and bronchial asthma.

3rd grade

The drugs are potassium channel antagonists, with a slowdown in electrical processes in the cellular structures of the heart muscle. Amiodarone is a commonly prescribed drug in this subgroup.

The drug gradually accumulates in tissue structures and is released at the same rate. The maximum efficiency is recorded three weeks after the start of administration. After discontinuation of the drug, the antiarrhythmic effect may persist for the next five days.

• with supraventricular and ventricular arrhythmia;
• atrial fibrillation;
• rhythm disturbances against the background of Wolff-Parkinson-White pathology;
• to prevent ventricular arrhythmias in acute myocardial infarction;
• with persistent atrial fibrillation - to suppress the frequency of contractions of the heart muscle.

Prolonged and uncontrolled medication can provoke:

• interstitial fibrosis of lung tissue;
• fear of sunlight;
• changes in the shade of the skin - with staining in purple;
• violation of the functionality of the thyroid gland - at the time of therapy, mandatory monitoring of thyroid hormone levels is carried out;
• decreased visual acuity;
• night sleep disturbances;
• lowering the level of memory;
• ataxia;
• paresthesia;
• sinus bradycardia;
• slowing down the process of intracardiac conduction;
• nausea;
• vomiting;
• constipation;
• arrhythmogenic effects - are recorded in 5% of patients who were prescribed medication.

The drug is toxic to the fetus. Use is prohibited:

• initial type of bradycardia;
• pathology of intracardiac conduction;
• hypotension;
• bronchial asthma;
• diseases with damage to the thyroid gland;
• period of gestation.

If there is a need to combine a drug with cardiac glycosides, then their dosage is halved.

4th grade

Drugs can block the passage of calcium ions, lowering the automatic reactions of the sinus node and suppressing pathological foci in the atrial zone. The main frequently recommended drug in this subgroup is Veropamil.

The drug has a positive effect in the treatment and prophylactic effect on attacks of supraventicular tachycardia, extrasystole. The drug is necessary to suppress the frequency of ventricular contractions, at the time of atrial flutter and fibrillation.

The drug does not have the necessary effect on the ventricular forms of rhythmic contractions of the organ. Negative reactions of the body to taking the medication are expressed:

• sinus bradycardia;
• atrioventricular block;
• a sharp drop in blood pressure;
• decrease in the ability of the heart muscle to contract.

The ban on the use of the drug are:

• severe forms of insufficient organ efficiency;
• cardiogenic shock conditions;
• atrioventricular blocking;
• pathology of Wolff-Parkinson-White syndrome - the use can provoke an increase in the rate of contractions of the ventricles.

Other drugs with antiarrhythmic activity

The above subgroups of antiarrhythmic drugs do not include individual drugs with a similar positive effect on the heart muscle. Therapy can be carried out:

• cardiac glycosides - to reduce the rate of organ contraction;
• cholinolytics - drugs are prescribed to increase the heart rate with severe bradycardia;
• magnesium sulfate - for the appearance of a pathological process of the "feasting" type - non-standard ventricular tachycardia, which is formed under the influence of electrolyte metabolism disorders, a liquid protein diet and prolonged exposure to certain antiarrhythmic drugs.

Herbal products

Medicinal plants are quite effective means for the treatment of the pathological process. They are included in the composition of individual drugs and are officially recognized by medicine. Stabilization of heart rate indicators is performed:

1. Alcohol tincture of motherwort herb - the recommended dosage should not exceed 30 units, the drug is consumed up to three times a day. It is allowed to manufacture a home form of a drug, but it is freely sold in pharmacy chains and the long preparation process does not make logical sense.
2. Valerian - in free sale it can be found in the form of tinctures, tablets, herbal raw materials. The healing substance helps to suppress pain, restore the rhythm of contraction of the heart muscle, and has a calming effect. If long-term therapy is needed, then an antidepressant and a drug for problems with night sleep.
3. Persenom - refers to antiarrhythmic, antispasmodic, sedative substances that help normalize appetite and night sleep. An additional effect of the drug is to relieve psycho-emotional overstrain, suppress the constantly present irritability, and treat nervous fatigue.

What is prescribed most often for arrhythmias of various types

• Verapamil;
• Adenosine;
• Phenilin;
• Quinidin (Durules);
• Warfarin (Nycomed).

In addition to medications, treatment necessarily includes the use of multivitamin complexes.

Combination of antiarrhythmic drugs

Pathological rhythm in clinical practice allows you to combine individual drug subgroups. If we take the drug Quinidine as an example, then it is allowed to be used in conjunction with cardiac glycosides - to suppress the negative symptoms of constantly present extrasystole.

Together with beta-blockers, a drug substance is used to suppress ventricular forms of arrhythmic abnormalities that are not amenable to other types of therapy. The combined use of beta-blockers and cardiac glycosides makes it possible to achieve high rates of efficiency in tachyarrhythmias, focal tachycardias, and ventricular extrasystoles.

Side effects

Drugs of this subclass can provoke negative reactions of the body in response to their use:

• provoking arrhythmic abnormalities;
• spontaneous headaches;
• periodic dizziness;
• convulsive conditions;
• short-term loss of consciousness;
• tremor of the upper and lower extremities;
• constant sleepiness;
• lowering blood pressure;
• doubling of objects before the eyes;
• sudden stop of respiratory function;
• insufficient functionality of the kidneys;
• dyspeptic disorders;
• bronchospasm;
• problems with the process of urination;
• increased dryness of the mucous membranes of the oral cavity;
• allergic reactions;
• drug fever;
• leukopenia;
• thrombocytopenia.

Antiarrhythmic drugs (AAPs) can correct serious disorders in the work of the heart and significantly prolong the life of patients.

Means that are included in this group differ significantly in their mechanism of action, affecting different components of the process of cardiac contraction. All antiarrhythmic drugs of the new and old generation are dispensed by prescription and are selected for each patient individually.

Classification of antiarrhythmics by mechanism of action

This classification is the most commonly used.

It characterizes medicines according to the mechanism of action:

• membrane stabilizing agents;
• beta-blockers;
• drugs that slow down repolarization;
• calcium ion antagonists.

The process of contraction of the heart occurs by changing the polarization of cell membranes.

The correct charge is provided by electrophysiological processes and ion transport. All antiarrhythmic drugs result in the desired therapeutic effect by influencing cell membranes, however, the process of influence is different for each subgroup.

Depending on what pathology caused the heart rhythm disturbance, the doctor decides on the appointment of a certain pharmacological group of anti-arrhythmia pills.

Membrane stabilizers

Membrane stabilizing agents fight arrhythmia by stabilizing the membrane potential in heart muscle cells.

These drugs are further divided into three types:

• ia. Normalize heart contractions by activating the transport of ions through sodium channels. These include quinidine, procainamide.
• IB. This includes drugs that are local anesthetics. They affect the membrane potential in cardiomyocytes by increasing the permeability of the membranes for potassium ions. Representatives - phenytoin, lidocaine, trimekain.
• IC. They have an antiarrhythmic effect by inhibiting the transport of sodium ions (the effect is more pronounced than that of group IA) - Etatsizin, Aymalin.

Group IA quinidine drugs also have other beneficial effects in normalizing the heart rhythm. For example, they increase the threshold of excitability, eliminate the conduction of unnecessary impulses and contractions, and also slow down the recovery of membrane reactivity.

Beta blockers

These drugs can be further divided into 2 subgroups:

• Selective - block only beta1 receptors that are located in the heart muscle.
• Non-selective - additionally block beta2 receptors located in the bronchi, uterus and blood vessels.

Selective drugs are more preferable, since they directly affect the myocardium and do not cause side effects from other organ systems.

The work of the conduction system of the heart is regulated by various parts of the nervous system, including the sympathetic and parasympathetic. If the sympathetic mechanism is disturbed, incorrect arrhythmogenic impulses may enter the heart, which lead to a pathological spread of excitation and the appearance of arrhythmia. The drugs of the second class (from the group of beta-blockers) eliminate the influence of the sympathetic system on the heart muscle and the atrioventricular node, due to which they exhibit antiarrhythmic properties.

List of the best representatives of this group:

• metoprolol;
• propranolol (additionally has a membrane-stabilizing effect as class I antiarrhythmic drugs, which enhances the therapeutic effect);
• bisoprolol (Concor);
• timolol;
• betaxolol;
• sotalol (Sotahexal, Sotalex);
• atenolol.

Beta-blockers positively affect the functioning of the heart from several sides. By lowering the tone of the sympathetic nervous system, they reduce the flow of adrenaline or other substances into the myocardium, which lead to excessive stimulation of the heart cells. Protecting the myocardium and preventing electrical instability, the drugs of this group are also effective in the fight against atrial fibrillation, sinus arrhythmia, and angina pectoris.

Most often, from this group, doctors prescribe drugs based on propranolol (Anaprilin) ​​or metoprolol. Drugs are prescribed for long-term regular use, but may cause side effects. The main ones are difficulty in bronchial patency, deterioration in the condition of patients with diabetes mellitus due to possible hyperglycemia.

Medications that slow repolarization

During the transport of ions through the cell membrane, an action potential arises, which forms the basis for the physiological conduction of a nerve impulse and contraction of myocardial tissue. After local excitation has occurred and a local response has arisen, the repolarization phase begins, which returns the membrane potential to its original level. Class 3 antiarrhythmics increase the duration of the action potential and slow down the repolarization phase by blocking potassium channels. This leads to a prolongation of impulse conduction and a decrease in sinus rhythm, but the overall contractility of the myocardium remains normal.

The main representative of this class is amiodarone (Kordarone). It is most often prescribed by cardiologists because of its wide therapeutic effect. Amiodarone can be used to treat arrhythmias of any origin. It also acts as an ambulance drug for emergencies or deterioration of the patient's condition.

Amiodarone exhibits antiarrhythmic and bradycardic effects, slows down nerve conduction in the atria, and increases the refractive period. Important properties are also considered to be a decrease in myocardial oxygen demand and an increase in coronary blood flow. As a result, the heart is able to function more fully and is not subject to ischemia. Antianginal action has found its application in the treatment of heart failure and coronary artery disease.

In addition to Amiodarone, this group of drugs includes:

• ibutilide;
• bretylium tosylate;
• tedisamil.

Blockers of slow calcium channels

Tablets from arrhythmia of the fourth group lead to the desired pharmacological effect due to the ability to block calcium channels. Calcium ions contribute to the contraction of muscle tissue, therefore, when the channel is closed, excess myocardial conduction is eliminated. The main representative is Verapamil. It is prescribed for the relief of palpitations, the treatment of extrasystole, the prevention of increased frequency of ventricular and atrial contractions. All drugs with antiarrhythmic effect are prescribed only by a doctor.

In addition to Verapamil, this group includes diltiazem, bepridil, nifedipine.

Choice of treatment, depending on the type of arrhythmia

Arrhythmia is a disorder in the work of the heart. Its manifestations are rapid, slow or uneven contraction of the myocardium.

The causes of arrhythmia and the mechanisms of its occurrence may differ. Treatment tactics are selected individually after a detailed examination and determination of the localization of the process that led to abnormal myocardial contractility.

The therapy strategy includes the following steps:

• The doctor assesses the threat to hemodynamics from the presence of arrhythmia and decides on the need for treatment in principle.
• The risk of other complications due to arrhythmia is assessed.
• The subjective attitude of the patient to attacks of arrhythmia and his well-being at these moments are assessed.
• The degree of aggressiveness of therapy is determined - mild, conservative, radical.
• A thorough examination of the patient is carried out to identify the cause of the disease. After that, the doctor evaluates whether there is a possibility of etiotropic therapy. A detailed examination in some patients reveals that the cause of the disease lies in psychological causes, so the treatment tactics will change dramatically (sedative sedatives will be used).
• Having chosen a treatment strategy, the doctor selects the most appropriate medication. This takes into account the mechanism of action, the likelihood of complications, the type of arrhythmia detected.

Beta-blockers are prescribed mainly for supraventricular arrhythmias, class IB drugs for ventricular imbalances, calcium channel blockers are effective for extrasystoles and paroxysmal tachycardia. Membrane stabilizers and class 3 antiarrhythmics are considered more versatile and are used for arrhythmias of any origin.

The first couple of weeks of treatment, it is necessary to carefully monitor the patient's condition. After a few days, a control ECG is performed, which is then repeated several more times. With positive dynamics, the interval of control studies may increase.

The choice of dose does not have a universal solution. More often, the dosage is selected in a practical way. If a therapeutic amount of the drug causes side effects, the doctor may use a combination regimen in which the dose of each arrhythmia drug is reduced.

With tachycardia

Treatment methods for tachycardia depend on the etiology of the latter. Indications for the constant use of antiarrhythmic drugs are cardiac causes. However, before starting treatment, it is necessary to exclude neurological causes (home problems, stress at work) and hormonal disorders (hyperthyroidism).

Medications that help reduce a rapid heart rate:

• Diltiazem.
• Sotahexal.
• Bisoprolol.
• Adenosine

Most drugs come in the form of tablets or capsules. They are inexpensive and self-administered by the patient at home, usually in combination with blood thinners. With paroxysms (powerful attacks of rapid heartbeat or pulse), injectable forms of drugs are used.

With extrasystole

If systolic contractions occur up to 1200 per day, and they are not accompanied by dangerous symptoms, the disease is considered potentially safe. For the treatment of extrasystole, a group of membrane stabilizers can be prescribed. In this case, the doctor can prescribe funds from any subgroup, in particular, class IB drugs are used primarily for the treatment of ventricular extrasystoles.

The positive effect of calcium channel blockers, which are able to relieve tachyarrhythmia or excessive heart contractions, has also been noted.

• Ethacizin.
• Propafenone.
• Propanorm.
• Allapinin.
• Amiodarone.

With the ineffectiveness of removing extrasystoles with modern drugs, as well as with a frequency of extrasystolic contractions of more than 20,000 per day, non-drug methods can be used. For example, radiofrequency ablation (RFA) is a minimally invasive surgical procedure.

For atrial fibrillation and flutter

When a person has atrial flutter or fibrillation, there is usually an increased risk of thrombosis. The treatment regimen includes drugs for arrhythmias and.

The list of drugs that stop excessive atrial fibrillation and flutter:

• Quinidine.
• Propafenone.
• Ethacizin.
• Allapinin.
• Sotalol.

Anticoagulants are added to them - aspirin or indirect anticoagulants.

With atrial fibrillation

In atrial fibrillation, the main drugs should also be combined with anticoagulant drugs. It is impossible to recover from the disease forever, therefore, in order to maintain a normal heart rhythm, you will have to drink medicines for many years.

For treatment are prescribed:

• Ritmonorm, Kordaron - to normalize the heart rhythm.
• Verapamil, Digoxin - for a reduced frequency of ventricular contractions.
• Non-steroidal drugs, anticoagulants - for the prevention of thromboembolism.

There is no universal cure for all arrhythmias. Amiodarone has the widest therapeutic effect.

Possible side effects

Pacemakers, adrenomimetics, and antiarrhythmic drugs can cause a number of undesirable effects. They are caused by a complex mechanism of action that affects not only the heart, but also other body systems.

According to patient reviews and pharmacological studies, antiarrhythmic drugs provoke the following side effects:

• stool disorder, nausea, anorexia;
• fainting, dizziness;
• change in the blood picture;
• impaired visual function, numbness of the tongue, noise in the head;
• bronchospasm, weakness, cold extremities.

The most popular drug, Amiodarone, also has a fairly wide range of undesirable manifestations - tremor, impaired liver or thyroid function, photosensitivity, visual impairment.

The manifestation of an arrhythmogenic effect in old age is another side effect in which the patient, on the contrary, provokes arrhythmias, fainting occurs and blood circulation is disturbed. It is caused more often by ventricular tachycardia or by taking a drug that has a proarrhythmic effect. That is why the treatment of any cardiac diseases should be carried out only by a doctor, and all such drugs belong to the prescription group.

Contraindications to most drugs:

• use in pediatrics;
• appointment for pregnant women;
• the presence of AV blockade;
• bradycardia;
• deficiency of potassium and magnesium.

Interaction with other drugs

Acceleration of the metabolism of antiarrhythmic drugs is observed when taken simultaneously with inducers of microsomal liver enzymes or alcohol. Metabolic slowdown occurs when combined with liver enzyme inhibitors.

Lidocaine enhances the effect of anesthetics, sedatives, hypnotics and muscle relaxants.

With the combined use of drugs for arrhythmia, they enhance the effects of each other.

Combining funds with non-steroidal drugs is possible (for example, with Ketorol in ampoules or tablets, as well as Aspirin Cardio), in order to obtain a blood-thinning effect or treat comorbidities.

Before starting treatment, you must tell the doctor about all the medicines that the patient is taking.

Other groups of drugs for the treatment of rhythm disorders

There are drugs that are able to regulate the heart rate directly or indirectly, but they belong to other pharmacological groups. These are preparations of cardiac glycosides, adenosine, magnesium and potassium salts.

Cardiac glycosides affect the conduction system of the heart by regulating autonomic activity. They often become the drugs of choice in patients with heart failure or hypertension. Adenosine triphosphate is a substance that takes part in many important electrophysiological processes in the human body. In the atrioventricular node, it helps to slow down impulse conduction and successfully fights tachycardia. This group includes the drug Riboxin, a precursor of ATP.

Tranquilizers with sedatives are prescribed for neurogenic arrhythmia etiology.

Magnesium preparations with potassium (Panangin) are also used to treat arrhythmias and flickering due to the participation of these elements in the mechanism of muscle contraction. They are called "vitamins for the heart." Normalization of the concentration of ions inside and outside the cell has a positive effect on myocardial contractility and its metabolism.

Antiarrhythmic drugs are used to eliminate or prevent heart rhythm disturbances of various etiologies. They are divided into drugs that eliminate tachyarrhythmias. and agents effective in bradyarrhythmias.

Ventricular fibrillation followed by asystole is responsible for 60-85% of sudden deaths, primarily in cardiac patients. In many of them, the heart is still quite capable of contractile activity and could work for many years. At least 75% of patients with myocardial infarction and 52% of patients with heart failure suffer from progressive cardiac arrhythmias.

Chronic, recurrent forms of arrhythmias accompany heart diseases (valvular defects, myocarditis, coronary insufficiency, cardiosclerosis, hyperkinetic syndrome) or occur against the background of violations of the neuroendocrine regulation of cardiac activity (thyrotoxicosis, pheochromocytoma). Arrhythmias develop during intoxication with nicotine, ethyl alcohol, cardiac glycosides, diuretics, caffeine, anesthesia with halogen-containing general anesthetics, operations on the heart, blood vessels, and lungs. Cardiac arrhythmias are often a vital indication for emergency therapy with antiarrhythmic drugs. In recent years, the paradoxical fact has been established that antiarrhythmic drugs can cause dangerous arrhythmias. This limits their use in arrhythmias with minimal clinical manifestations.

In 1749, it was proposed to take quinine for "persistent palpitations." In 1912, to Karl Friedrich Wenckebach (1864-1940), a well-known German cardiologist who described the blockade of Wenckebach. the merchant asked about an attack of palpitations. Wenckebach diagnosed atrial fibrillation, but explained to the patient that its relief with drugs is not possible. The merchant expressed doubts about the medical competence of cardiologists and decided to treat himself. He took 1 gram of quinine powder, which in those days had a reputation as a remedy for all diseases. After 25 minutes, the heart rate returned to normal. Since 1918, the dextrorotatory isomer of quinine, quinidine, has been introduced into medical practice on the recommendation of Wenckebach.

Under normal conditions, the function of the pacemaker is performed by the sinus node. Its P-cells (name - from the first letter of the English word racemaker) have automatism - the ability to spontaneously. generate an action potential during diastole. The resting potential of P-cells is from -50 to -70 mV, depolarization is caused by incoming flows of calcium ions. In the structure of the membrane potential of P-cells, the following phases are distinguished:

Phase 4 - slow spontaneous diastolic depolarization of the calcium type; phase 0 - development of a positive action potential + 20-30 mV after reaching the threshold value of depolarization in phase 4;

Phase 1 - rapid repolarization (input of chloride ions);

Phase 2 - slow repolarization (exit of potassium ions and slow entry of calcium ions);

Phase 3 - final repolarization with the restoration of a negative resting potential.

During the resting potential, the ion channels are closed (external activation and internal inactivation gates are closed); during depolarization, the channels open (both types of gates are open);

Action potentials from P-cells of the sinus node propagate along the conduction system of the atria, the atrioventricular node and the intraventricular system of His-Purkinje fibers (in the direction from the endocardium to the epicardium). In the conducting system of the heart, the cells are long and thin, they contact each other in the longitudinal direction, and have rare lateral connections. Conduction of action potentials occurs 2-3 times faster along the cells than in the transverse direction. The speed of impulse conduction in the atria is -1 m / s, in the ventricles - 0.75-4 m / s.

On the ECG wave R corresponds to atrial depolarization, complex ORS - ventricular depolarization (phase 0), segment ST - repolarization phases 1 and 2, tooth T - phase of repolarization 3.

In the conduction system of a healthy heart, distal to the sinus node, spontaneous depolarization proceeds much more slowly than in the sinus node, therefore, it is not accompanied by an action potential. There is no spontaneous depolarization in the contractile myocardium. The cells of the conduction system and contractile myocardium are excited by impulses from the sinus node. In the atrioventricular node, spontaneous depolarization is caused by the entry of calcium and sodium ions, in the Purkinje fibers - the entry of only sodium ions ("sodium" potentials).

The rate of spontaneous depolarization (phase 4) is regulated by the autonomic nervous system. With an increase in sympathetic influences, the entry of calcium and sodium ions into cells increases, which accelerates spontaneous depolarization. With an increase in parasympathetic activity, potassium ions come out more intensively, slowing down spontaneous depolarization.

During the action potential, the myocardium is in a state of refractoriness to irritation. With absolute refractoriness, the heart is not capable of excitation and contraction, regardless of the strength of stimulation (phase 0 and the beginning of repolarization); at the beginning of the relative refractory period, the heart is excited in response to a strong stimulus (the final stage of repolarization), at the end of the relative refractory period, the excitation is accompanied by a contraction.

The effective refractory period (ERP) covers the absolute refractory period and the initial part of the relative refractory period, when the heart is capable of weak excitation, but does not contract. On the ECG, ERP corresponds to the complex QRS and the ST segment.

PATHOGENESIS OF ARRHYTHMIAS

Tachyarrhythmias occur as a result of violations of impulse formation or circulation of a circular wave of excitation.

Violation of impulse formation

In patients with arrhythmia, heterotopic and ectopic pacemakers appear in the myocardium, which have more automatism than the sinus node.

Heterotopic foci are formed in the conducting system distal to the sinus node.

Ectopic foci appear in the contractile myocardium.

Impulses from additional foci cause tachycardia and extraordinary contractions of the heart.

A number of factors contribute to the "unleashing" of anomalous automatism:

The occurrence or acceleration of spontaneous depolarization (the entry of calcium and sodium ions is facilitated under the influence of catecholamines, hypokalemia, stretching of the heart muscle);

Reducing the negative resting diastolic potential (myocardial cells contain an excess of calcium and sodium ions during hypoxia, blockade Na/TO-ATPase and calcium-dependent ATPase);

ERP reduction (potassium and calcium conductivity increases in phase 2. Development of the next action potential accelerates);

Weakness of the sinus node with a rare generation of impulses;

Release of the conduction system from the control of the sinus node in the conduction block (myocarditis, cardiosclerosis).

Trigger activity is manifested by early or late trace depolarization. Early trace depolarization, interrupting phases 2 or 3 of the transmembrane potential, occurs with bradycardia, a low content of potassium and magnesium ions in the extracellular fluid, and excitation of p-adrenergic receptors. It causes polymorphic ventricular tachycardia (torsades de pointes). Late trace depolarization develops immediately after the end of repolarization. This type of trigger activity is due to overload of myocardial cells with calcium ions during tachycardia, myocardial ischemia, stress, poisoning with cardiac glycosides.

circular wave of excitation

Excitation wave circulation reentry - repeated admission) contributes to heterochronism - a mismatch in time of the refractory period of myocardial cells. Circular wave of excitation, meeting refractory depolarized tissue in the main pathway. is sent along an additional path. but may return in the antidromic direction along the main path. if the refractory period has ended in it. Ways for the circulation of excitation are created in the border zone between the scar tissue and the intact myocardium. The main circular wave breaks up into secondary waves that excite the myocardium, regardless of the impulses from the sinus node. The number of extraordinary contractions depends on the period of circulation of the wave before attenuation.

CLASSIFICATION OF ANTI-ARITHMIC DRUGS

The classification of antiarrhythmic drugs is carried out according to their effect on the electrophysiological properties of the myocardium (E.M. Vaug-han Williams, 1984; D.C. Hamson. 1985) (Table 38.2).

Almost all patients of the cardiologist faced one way or another with various kinds of arrhythmias. Currently, the pharmacological industry offers a wide variety of antiarrhythmic drugs. Their classification and characteristics will be considered in this article.

Ways of exposure

To eliminate ectopic heart rhythm disturbances, antiarrhythmic drugs are prescribed. The mechanism of action of such drugs is aimed at the electrophysiological properties of working myocardial cells:

Classification of antiarrhythmic drugs

All medicines in this group are divided into four classes. Additionally, the first class is divided into three more subclasses. This classification is based on the degree to which drugs affect the ability of heart cells to generate and conduct electrical signals. Different classes of antiarrhythmic drugs have their own routes of action, so their effectiveness will differ for different types of arrhythmia.

The first class includes blockers of fast sodium channels. Subclass IA includes drugs such as Quinidine, Disopyramide, Novocainamide, Gilurithmal. Subclass IB includes Pyromecaine, Tocainide, Difenin, Lidocaine, Aprindine, Trimecaine, Mexiletine. The IC subclass is formed by such agents as Etmozin, Ritmonorm (Propafenone), Allapinin, Etacizin, Flecainide, Indecainide, Bonnecor, Lorcainide.

The second class is made up of beta-blockers (Metoprolol, Nadolol, Alprenolol, Kordanum, Propranolol, Acebutalol, Pindolol, Trazikor, Esmolol).

The third class includes potassium channel blockers: Bretilium tosylate, Amiodarone, Sotalol.

The fourth class includes blockers of slow calcium channels (for example, "Verapamil").

The list of antiarrhythmic drugs does not end there. Potassium chloride, sodium adenosine triphosphate, and magnesium sulfate are also isolated.

First class drugs

Blockers of fast sodium channels stop the flow of sodium into the cells, which slows down the passage of the excitation wave through the myocardium. Thanks to this, the conditions for rapid circulation of pathological signals in the heart are stopped, and the arrhythmia is eliminated. Let us consider in more detail the groups of antiarrhythmic drugs belonging to the first class.

Class IA drugs

Such antiarrhythmic drugs are prescribed for and supraventricular), as well as to restore sinus rhythm in case of atrial fibrillation (atrial fibrillation). In addition, they are used to prevent recurrent attacks.

"Novocainamide" and "Quinidine" are effective antiarrhythmic drugs for tachycardia. Let's talk about them in more detail.

"quinidine"

This medicine is used in case of paroxysmal and paroxysmal atrial fibrillation to restore sinus rhythm. Most often, the medicine is prescribed in the form of tablets.

Poisoning with antiarrhythmic drugs is rare, but when taking Quinidine, side effects are possible in the form of indigestion (vomiting, loose stools) and headache. In addition, the use of this medication can cause a decrease in the level of platelets in the blood, a slowdown in intracardiac conduction, and a decrease in myocardial contractility. The most dangerous side effect is the development of a special form of ventricular tachycardia, which can cause sudden death of the patient. That is why Quinidine therapy should be carried out only with the control of the electrocardiogram and under the supervision of a specialist.

The drug is contraindicated in intraventricular and atrioventricular blockade, intoxication with cardiac glycosides, thrombocytopenia, arterial hypotension, heart failure, pregnancy.

"Novocainamide"

This medication has the same indications for use as Quinidine. Quite often it is prescribed for the purpose of stopping paroxysms of atrial fibrillation. With an intravenous injection of Novocainamide, a sharp decrease in blood pressure is possible, as a result of which it is necessary to administer the solution as slowly as possible.

Among the side effects are nausea, vomiting, changes in the composition of the blood, disorders of the nervous system in the form of dizziness, headache, in rare cases, confusion. If you use the drug constantly, a lupus-like syndrome (serositis, arthritis, fever), a microbial infection in the oral cavity, accompanied by slow healing of wounds and ulcers and bleeding gums, may develop. In addition, Novocainamide can provoke an allergic reaction, in this case, the first sign will be the appearance of muscle weakness when the drug is administered.

It is forbidden to use the medication for atrioventricular blockade, severe forms of renal and heart failure, arterial hypotension and cardiogenic shock.

Class IB

Such drugs have little effect on the sinus node, atrioventricular junction and atria, and therefore are ineffective in the case of supraventricular arrhythmias. These antiarrhythmic drugs are prescribed for extrasystole, paroxysmal tachycardia, that is, for the treatment of ventricular arrhythmias. They are also used to treat arrhythmias, which are provoked by an overdose of cardiac glycosides.

The list of antiarrhythmic drugs of this class is quite extensive, but the most commonly used remedy is Lidocaine. As a rule, it is administered intravenously in case of severe ventricular arrhythmias, including myocardial infarction.

"Lidocaine" can disrupt the functioning of the nervous system, which is manifested by dizziness, convulsions, problems with speech and vision, and a disorder of consciousness. If you enter the drug in a large dose, it is possible to slow down the heart rate, reduce the contractility of the heart. In addition, allergic reactions are likely in the form of Quincke's edema, urticaria, skin itching.

"Lidocaine" is contraindicated in atrioventricular blockade, syndrome The drug is not prescribed in case of severe supraventricular arrhythmia, since the risk of atrial fibrillation increases.

IC class

Drugs belonging to this class lengthen intracardiac conduction, especially in the His-Purkinje system. They have pronounced arrhythmogenic properties, so they are currently used to a limited extent.

The list of antiarrhythmic drugs of this class was given above, but of these, only Propafenone (Ritmonorm) is mainly used. It is prescribed for supraventricular and ventricular arrhythmias, including with ERW syndrome. Since there is a risk of an arrhythmogenic effect, the medication should be used under the supervision of a doctor.

In addition to arrhythmias, this drug can cause progression of heart failure and deterioration of cardiac contractility. Side effects include a metallic taste in the mouth, nausea and vomiting. Such negative effects as visual disturbances, changes in the blood test, dizziness, insomnia, and depression are not excluded.

Beta blockers

When the tone of the sympathetic nervous system increases, for example, in case of stress, hypertension, vegetative disorder, ischemia, many catecholamines appear in the blood, including adrenaline. These substances act on myocardial beta-adrenergic receptors, which leads to electrical cardiac instability and the appearance of arrhythmias.

Beta-blockers prevent excessive stimulation of receptors and thus protect the myocardium. In addition, they reduce the excitability of the cells of the conduction system, which leads to a slowdown in the heart rate.

Medicines of this class are used in the treatment of flutter and atrial fibrillation, for the prevention and relief of supraventricular arrhythmias. In addition, they help to overcome sinus tachycardia.

Ineffective considered antiarrhythmic drugs for atrial fibrillation, except in cases where the pathology is caused precisely by an excess of catecholamine in the blood.

For the treatment of rhythm disturbances, Metoprolol and Anaprilin are often used. These drugs have side effects in the form of a slowing of the pulse, a decrease in myocardial contractility, and the occurrence of atrioventricular blockade. These medications can provoke cold extremities and deterioration of peripheral blood flow. In addition, drugs affect the nervous system, causing drowsiness, dizziness, depression, and memory impairment. They also change the conductivity in the nerves and muscles, which is manifested by fatigue and weakness.

Beta-blockers are prohibited for use in cardiogenic shock, pulmonary edema, insulin-dependent diabetes mellitus, bronchial asthma. Also contraindications are atrioventricular blockade of the second degree, sinus bradycardia.

Potassium channel blockers

The list of antiarrhythmic drugs in this group includes drugs that slow down electrical processes in the cells of the heart and thereby block potassium channels. The most famous drug of this class is Amiodarone (Cordarone). Among other things, it acts on M-cholinergic and adrenergic receptors.

"Kordaron" is used for the treatment and prevention of ventricular, atrial and supraventricular arrhythmias, heart rhythm disturbances against the background of ERW syndrome. The drug is also prescribed to prevent life-threatening ventricular arrhythmias in patients with acute myocardial infarction. In addition, it is used to reduce the heart rate in persistent atrial fibrillation.

If you use the product for a long time, an interstitial change in skin color (appearance of a purple hue) may develop. In some cases, there are headaches, sleep disturbances, memory, vision. Reception of "Amiodarone" can cause the development of sinus bradycardia, constipation, nausea and vomiting.

Do not prescribe medication for initial bradycardia, prolongation of the QT interval, impaired intracardiac conduction, thyroid diseases, arterial hypotension, pregnancy, bronchial asthma.

Blockers of slow calcium channels

These drugs block the slow flow of calcium, thereby suppressing ectopic foci in the atria and reducing the automatism of the sinus node. The list of antiarrhythmic drugs in this group includes "Verapamil", which is prescribed for the prevention and relief of paroxysms of supraventricular tachycardia, for the treatment of supraventricular extrasystole. "Verapamil" is ineffective in case of ventricular arrhythmias.

Side effects include atrioventricular block, sinus bradycardia, and in some cases, a decrease in cardiac contractility.

cardiac glycosides

The classification of antiarrhythmic drugs will not be complete without mentioning these drugs. These include drugs such as Celanide, Korglikon, Digitoxin, Digoxin, etc. They are used to restore sinus rhythm, stop supraventricular tachycardia, and reduce the frequency of ventricular contractions in case of atrial fibrillation. When using cardiac glycosides, you need to monitor your condition. Signs are manifested by abdominal pain, nausea and vomiting, headaches, visual and sleep disturbances, nosebleeds.

It is forbidden to use these antiarrhythmic drugs for bradycardia, SVC syndrome, intracardiac blockades. They are not prescribed in the case of paroxysmal ventricular tachycardia.

Combination of antiarrhythmic drugs

With ectopic rhythms, some combinations of medications are used in clinical practice. So, "Quinidine" can be used in conjunction with cardiac glycosides for the treatment of persistent extrasystole. With beta-blockers, Quinidine can be prescribed to stop ventricular arrhythmias that are not amenable to other treatment. The combined use of beta-blockers and cardiac glycosides gives a good effect in ventricular and supraventricular extrasystoles, and also helps to prevent recurrence of tachyarrhythmias and ectopic tachycardias.

Antiarrhythmic drugs are drugs used to normalize the rhythm of heart contractions. These chemical compounds belong to various pharmacological classes and groups. They are designed to treat and prevent their occurrence. Antiarrhythmics do not increase life expectancy, but are used to control clinical symptoms.

Antiarrhythmic drugs are prescribed by cardiologists if the patient has a pathological arrhythmia, which worsens the quality of life and can lead to the development of severe complications. Antiarrhythmic drugs have a positive effect on the human body. They should be taken for a long time and only under the control of electrocardiography, which is carried out at least once every three weeks.

The cell wall of cardiomyocytes is permeated with a large number of ion channels through which potassium, sodium, and chloride ions move. This movement of charged particles leads to the formation of an action potential. Arrhythmia is caused by abnormal propagation of nerve impulses. To restore the rhythm of the heart, it is necessary to reduce activity and stop the circulation of the impulse. Under the influence of antiarrhythmic drugs, ion channels are closed and the pathological effect on the heart muscle of the sympathetic nervous system decreases.

The choice of an antiarrhythmic agent is determined by the type of arrhythmia, the presence or absence of structural pathology of the heart. When the necessary safety conditions are met, these drugs improve the quality of life of patients.

Antiarrhythmic therapy is primarily carried out to restore sinus rhythm. Patients are treated in a cardiological hospital, where they are intravenously or orally administered antiarrhythmic drugs. In the absence of a positive therapeutic effect, go to. Patients without concomitant chronic heart disease can restore sinus rhythm on their own on an outpatient basis. If attacks of arrhythmia occur rarely, are short and oligosymptomatic, patients are shown dynamic observation.

Classification

The standard classification of antiarrhythmic drugs is based on their ability to influence the production of electrical signals in cardiomyocytes and their conduction. They are divided into four main classes, each of which has its own path of exposure. The effectiveness of drugs for different types of arrhythmia will be different.

• Membrane stabilizing sodium channel blockers - Quinidine, Lidocaine, Flecainide. Membrane stabilizers affect the functionality of the myocardium.
• - "Propranolol", "Metaprolol", "Bisoprolol". They reduce mortality from acute coronary insufficiency and prevent recurrence of tachyarrhythmias. Drugs in this group coordinate the innervation of the heart muscle.
• Potassium channel blockers - Amiodarone, Sotalol, Ibutilide.
• - Verapamil, Diltiazem.
• Others:, sedatives, tranquilizers, neurotropic agents have a combined effect on myocardial function and its innervation.

Table: division of antiarrhythmics into classes

Representatives of major groups and their action

1A class

The most common class 1A antiarrhythmic drug is " Quinidine" which is made from the bark of the cinchona tree.

This drug blocks the penetration of sodium ions into cardiomyocytes, lowers the tone of arteries and veins, has an irritating, analgesic and antipyretic effect, and inhibits brain activity. Quinidine has a pronounced antiarrhythmic activity. It is effective in various types of arrhythmias, but causes side effects when dosed and applied incorrectly. Quinidine has an effect on the central nervous system, blood vessels and smooth muscles.

When taking the drug, it should not be chewed, so as not to get irritation of the gastrointestinal mucosa. For a better protective effect, it is recommended to take Quinidine with meals.

the effect of drugs of various classes on the ECG

1B class

Antiarrhythmic 1B class - "Lidocaine". It has antiarrhythmic activity due to its ability to increase membrane permeability to potassium and block sodium channels. Only significant doses of the drug can affect the contractility and conduction of the heart. The drug stops attacks of ventricular tachycardia in the postinfarction and early postoperative period.

To stop an arrhythmic attack, it is necessary to inject 200 mg of "Lidocaine" intramuscularly. In the absence of a positive therapeutic effect, the injection is repeated after three hours. In severe cases, the drug is administered intravenously in a stream, and then proceed to intramuscular injections.

1C class

Class 1C antiarrhythmics prolong intracardiac conduction, but have a pronounced arrhythmogenic effect, which currently limits their use.

The most common means of this subgroup is "Ritmonorm" or "Propafenone". This medicine is intended for the treatment of extrasystole, a special form of arrhythmia caused by premature contraction of the heart muscle. "Propafenone" is an antiarrhythmic drug with a direct membrane-stabilizing effect on the myocardium and a local anesthetic effect. It slows down the influx of sodium ions into cardiomyocytes and reduces their excitability. "Propafenone" is prescribed to persons suffering from atrial and ventricular arrhythmias.

Grade 2

Class 2 antiarrhythmics - beta-blockers. Under the influence "Propranolol" blood vessels dilate, blood pressure decreases, bronchial tone increases. In patients, the heart rhythm normalizes, even in the presence of resistance to cardiac glycosides. At the same time, the tachyarrhythmic form is transformed into a bradyarrhythmic form, the heartbeat and interruptions in the work of the heart disappear. The drug is able to accumulate in tissues, that is, there is a cumulation effect. Because of this, when using it in the elderly, doses must be reduced.

3rd grade

Class 3 antiarrhythmics are potassium channel blockers that slow down electrical processes in cardiomyocytes. The brightest representative of this group - "Amiodarone". It dilates the coronary vessels, blocks adrenoreceptors, lowers blood pressure. The drug prevents the development of myocardial hypoxia, reduces the tone of the coronary arteries, reduces heart rate. The dosage for admission is selected only by the doctor on an individual basis. Due to the toxic effect of the drug, its intake must be constantly accompanied by control of pressure and other clinical and laboratory parameters.

4th grade

Antiarrhythmic class 4 - "Verapamil". This is a highly effective remedy that improves the condition of patients with severe forms of angina pectoris, hypertension and arrhythmias. Under the influence of the drug, the coronary vessels expand, the coronary blood flow increases, the resistance of the myocardium to hypoxia increases, the rheological properties of the blood normalize. "Verapamil" accumulates in the body, and then excreted by the kidneys. It is produced in the form of tablets, dragees and injections for intravenous administration. The drug has few contraindications and is well tolerated by patients.

Other drugs with antiarrhythmic activity

Currently, there are many drugs that have an antiarrhythmic effect, but are not included in this pharmaceutical group. These include:

1. Cholinolytics, which are used to increase the heart rate in bradycardia - "Atropine".
2. Cardiac glycosides designed to slow down the heart rate - "Digoxin", "Strophanthin".
3. "Magnesium sulfate" used to stop an attack of a special ventricular tachycardia, called "pirouette". It occurs with severe electrolyte disturbances, as a result of long-term use of certain antiarrhythmic drugs, after a liquid protein diet.

Antiarrhythmic agents of plant origin

Herbal medicines have an antiarrhythmic effect. List of modern and most common drugs:

Side effects

The negative effects of antiarrhythmic therapy are represented by the following effects:

Cardiovascular diseases are a common cause of death, especially among middle-aged and elderly people. Heart disease provokes the development of other life-threatening conditions, such as arrhythmia. This is a serious enough health condition that does not allow self-treatment. At the slightest suspicion of the development of this disease, it is necessary to seek medical help, undergo a full examination and a full course of antiarrhythmic treatment under the supervision of a specialist.