Antiarrhythmic drugs include: Antiarrhythmic drugs: classification and description

herbal medicinal herbal medicine

A moderate hypotensive effect is inherent in motherwort, marsh cudweed, sweet clover, meadow geranium, hawthorn, blue cyanosis, Baikal skullcap, chokeberry, and woolly-flowered astragalus. The antispasmodic effect is due to flavonoids, coumarins, alkaloids and other substances. Anise, periwinkle, hawthorn, oregano, peppermint, parsnip, chamomile, fennel, and hops have this effect.

Blood red hawthorn (CrataegussanguineaPall)

Botanical description. There are three types of hawthorn. All of them are shrubs or small trees with straight spines planted on the shoots, of the Rosaceae family. Branches with shiny brown bark and thick straight spines up to 2.5 cm. Leaves are alternate, short-petiolate, obovate, serrated along the edge, covered with hairs, dark green above, lighter below. Hawthorn flowers are white or pinkish, collected in corymbs. The fruits are apple-shaped with 1-5 seeds, blood-red. Hawthorn blooms in May - July. Fruit ripening occurs in September - October.

Spreading. Widely cultivated as an ornamental plant. It is found in central Russia, in the forest-steppe regions of the Saratov and Samara regions, in the south of Siberia and the eastern regions of Central Asia. Grows in forests, steppe ravines, and bushes along rivers.

Preparation. Medicinal raw materials are flowers and fruits. Flowers are collected at the beginning of flowering, when some of them have not yet bloomed. Both whole inflorescences and individual flowers are used. Fruits collected at full ripening are used without stalks. Flowers are dried in the shade in the fresh air or in rooms with good ventilation. The finished raw materials should not contain leaves, peduncles, or browned flowers more than 3%. Drying fruits is also possible in the open air or in special dryers at a temperature of 50-60°C. The raw materials should not contain more than 1% unripe, moldy fruits; individual seeds and branches - no more than 2%; foreign impurities - no more than 1%. After drying, the raw materials are sorted, removing empty shields and spoiled fruits. The dried fruits are dark red or brownish-orange, with a sweet and astringent taste. Everything is stored in dry, well-ventilated areas. Chemical composition. Ursolic, oleanoic acids, saponins and flavonoids are found in hawthorn fruits. In addition, hyperoside, hyperin, tannins, sorbitol, choline and fatty oil were found. The leaves contain chlorogenic and caffeic acids, the flowers contain ursolic, oleanic, caffeic, quercetin and essential oil up to 0.16%. The seeds contain amygdalin glycoside and fatty oil.

Pharmachologic effect. Substances contained in hawthorn reduce the excitability of the central nervous system, eliminate palpitations and heart rhythm disturbances, relieve dizziness and discomfort in the heart area. Under the influence of the active principles of hawthorn, blood supply and contractility of the heart muscle are improved, while at the same time its excitability is reduced. Application. Hawthorn preparations are used for vegetative neuroses against the background of circulatory disorders, at the initial stage of hypertension, for tachycardia, for sleep disorders, especially caused by cardiac disorders, hypertension and hyperthyroidism. A positive effect of hawthorn preparations on the vascular wall has been established, which makes its use necessary for atherosclerosis. In large doses, hawthorn preparations dilate blood vessels in internal organs and the brain and lower blood pressure.

Small periwinkle (Vincaminor). Kutrov family

Botanical description. Lesser periwinkle is an evergreen shrub. The rhizome is cord-shaped, reaches a length of 60-70 cm, and is located horizontally. The stems are branched, recumbent or erect (flowering). Leaves with short petioles, pointed, ellipsoidal, are located opposite each other. Periwinkle flowers are large, axillary. The corolla is blue, funnel-shaped, and consists of 5 fused petals with a long narrow tube. The fruit consists of 2 cylindrical leaflets with many oblong seeds.

Spreading. It grows in the European part of Russia, Crimea, the Caucasus, Belarus, the Baltic states, and Transcarpathia. The plant is shade-tolerant, found in hornbeam and oak forests, on forest slopes, clearings, on rocky and gravelly soils. As an ornamental plant, it is grown in parks, gardens, and cemeteries.

Preparation. Flowering time is May, but secondary flowering is also possible: at the end of July or in August. Reproduction occurs most often vegetatively, fruiting is rare, the fruits ripen in July. Medicinal raw materials are flowers, stems, leaves, rhizomes. Stems and leaves are collected in spring and early summer. The upper part of the stems at a height of 2-5 cm is cut off, and the lower horizontal shoots are left untouched for further rooting. Drying of the grass is carried out in attics with good ventilation or under sheds, spread out in a layer of 3-4 cm. The grass is dried until ready in 7-10 days. Finished raw materials should not contain large, coarse stems. Vinca leaves are odorless and taste bitter. The raw materials are poisonous. It is stored in linen bags in dry rooms with good ventilation.

Chemical composition. Among the active ingredients of Vinca minor, the following indole alkaloids should be noted: vincamine, isovincamine, minorin, as well as bitterness, phytosterol, and tannins. In addition to them, rutin, malic, succinic acids, and flavonoids were found. All these active ingredients form the basis of the chemical composition of Vinca minor

The pharmacological properties of Vinca minor are determined by its chemical composition. Certain vinca alkaloids lower blood pressure, dilate the coronary vessels of the heart and blood vessels of the brain, relax the muscles of the small intestine and stimulate contractions of the uterus. The main alkaloid of the plant, vincamine, improves cerebral circulation and oxygen utilization by brain tissue. Ervin, vincarine, reserpine and ervin, belonging to the group of alkaloids, have antiarrhythmic activity. In Erwin these properties are most pronounced. This substance has anticholinesterase and α-adrenolytic activity, inhibits intracardiac conduction, and prevents the development of ventricular fibrillation.

Application. The Vinca minor plant has been used since ancient medicine as a sedative that reduces dizziness and headaches, and lowers blood pressure. It is used for hypertension, cerebral vascular spasms, neurogenic tachycardia and other autonomic neuroses. The hypotensive effect of the drugs is especially pronounced in patients with stage I-II hypertension, less than stage III. Vinca minor preparations have a positive effect on the functioning of the heart, increase the resistance of capillaries, and increase daily diuresis. They are low toxic. The effect of treatment with periwinkle lasts up to 3 months.

Swamp grass (Gnaphaliumuliginosum). Family Asteraceae.

Botanical description. This is an annual herbaceous plant 5-20 cm high. The root is thin, short, taproot. The stem branches strongly from the base. The leaves are linear or lanceolate, pointed, collected in a petiole. The flowers are small, tubular, light yellow in color, collected 1-4 in baskets at the ends of the branches, axillary. Flowering time is from June to September. The fruits are greenish-gray achenes with a tuft and ripen in August.

Spreading. Grows throughout Russia, except the south and Far East. It grows in damp places, swamps, along the banks of lakes and rivers, in flooded meadows, on arable land, in ditches, sometimes as a weed.

Preparation. The herb is used as a medicinal raw material, which is collected from July to September along with the roots, cleaned and dried. The finished raw material rustles when pressed, but does not break, has a weak aroma and a salty taste. It is packed in bags of 20-40-50 kg. Store in closed, ventilated areas. Shelf life 3 years.

The chemical composition of marsh cudweed has been little studied. It contains tannins, essential oil, resins, phytosterols, and carotene. Vitamins B1 and C, traces of alkaloids, and dyes were found.

Pharmachologic effect. Cushion preparations, when administered into a vein, cause dilation of peripheral vessels, which entails a decrease in blood pressure. In addition, there is a decrease in the number of heart contractions, a decrease in blood clotting time and activation of intestinal peristalsis.

To normalize heart rate, drugs belonging to completely different types of medications are used. But their effectiveness is based on the ability to influence the permeability of cell walls.

The myocardium and cardiac conduction system consists of cells whose walls have a large number of channels. Through them, sodium, potassium, chlorine and other components circulate in both directions.

This movement forms an electrical charge, that is, a potential that ensures contractions of the heart muscle. When the movement of ions through the walls through the channels is disrupted, pathological impulses arise, provoking the development of arrhythmia.

If the heart begins to “falter,” the use of special drugs stops the movement of ions through the walls and leads to their blockade. The pathological signal is interrupted, the organ restores its normal rhythm, and the manifestations of the problem disappear. The patient feels much better.

Classification

All antiarrhythmics are divided according to different principles: according to their effect on the heart muscle, on innervation, acting in both directions, but the most common is the division into classes:

• Class 1A - membrane stabilizers, that is, agents that restore the normal function of cell walls. These include Quinidine, Novocainamide, Disopyramide, Gilurythmal and others.
• Class 1B – drugs that increase the duration of the action potential. These are Lidocaine, Pyromecaine, Trimecaine, Tocainide, Mexiletine, Difenin, Aprindin.
• Class 1C - calcium ion antagonists, or calcium channel blockers. This class includes drugs such as Etatsizin, Ethmozin, Bonnecor, Propafenone (Ritmonorm), Flecainide, Lorcainide, Allapinin, Indecainide.

First class drugs are prescribed for extrasystole, ventricular and atrial fibrillation, and paroxysmal tachycardia.

• Class 2 - beta-blockers: Propranolol, Metoprolol, Acebutalol, Nadolol, Pindolol, Esmolol, Alprenolol, Trazikor, Cordanum. Drugs of this type are useful for and can reduce the risk of developing. Cardioselective medications include Epiloc, Atenolol and others. Propranolol has an antianginal effect.
• Class 3 - potassium channel blockers: Cordarone (Amiodarone), Bretilium tosylate, Sotalol.
• Class 4 – slow calcium channel blockers: Verapamil.

All medications of this type should be selected with special attention for patients with additional heart problems, such as bradycardia, bradyarrhythmia,
and other violations.

Other drugs

In cases where antiarrhythmic drugs belonging to the first four classes turn out to be ineffective or require additional action, drugs are used that are classified by some authors as a separate, fifth class. It includes the following tools:

• Potassium preparations. A lack of this mineral leads to changes in heart rate, shortness of breath, muscle weakness, especially in the lower extremities, cramps and paresis, and intestinal obstruction. Patients are prescribed potassium in the form of the following drugs: Panangin or Asparkam, Asparginate, Potassium orotate, Orocamag, Kalinor and others.
• Cardiac glycosides. This is a group of drugs for the treatment of different origins. They have antiarrhythmic and cardiotonic effects and improve myocardial performance. The preparations are based on plant materials, derivatives of such medicinal herbs as digitalis purpurea and woolly (Digitoxin and Digoxin), lily of the valley (Korglykon), spring adonis (Adonis-bromine), strophanthus Combe (Strophanthin K). Medicines can be dangerous in large quantities, since all of the listed plants are poisonous. During treatment, the dosage must be strictly followed. Glycosides are not used for some forms of arrhythmia, as they can cause ventricular extrasystole, and an overdose leads to fibrillation of the cardiac ventricles.
• Adenosine. This drug is given intravenously and causes a temporary block of the atrioventricular node of the heart. The product acts almost instantly - the effect appears within 20-30 minutes. Adenosine is used to stop attacks of tachycardia.
• Magnesium sulfate (magnesia, Epsom salts). This is a white mineral powder that has many beneficial properties. The drug is widely used and used for various purposes. It has the following effects: vasodilator, analgesic, antispasmodic, anticonvulsant, antiarrhythmic, choleretic, diuretic, laxative, sedative. For antiarrhythmic purposes, the drug is administered mainly intravenously.

Since arrhythmias often provoke thrombus formation, doctors prescribe a number of auxiliary drugs aimed at thinning the blood. The most famous is Aspirin, or acetylsalicylic acid. It not only has antithrombosis properties, but also has an anti-inflammatory and analgesic effect.

Latest generation products

Every year, the pharmaceutical industry produces more and more new antiarrhythmic drugs, which often use already used compounds, only better and more improved. Confusion is also caused by the appearance of many generics under new names, which are actually long-known drugs with a similar composition.

This once again indicates the need for mandatory prescription of such drugs by the attending physician and their individual selection through trial and error. What works perfectly for one patient may be completely ineffective for another.

The group of drugs actively prescribed by doctors includes Amiodarone, Arrythmil Cardio, Cardiodarone, Cordarone, Mioritmil, Rotaritmil, Propranolol, Ritmonorm, Verapamil and many other drugs.

Since such medications are selected individually, there is no single treatment regimen that is suitable for absolutely all patients, even if they have the same disease with similar symptoms.

Herbal preparations

If you do not take into account cardiac glycosides, the list of herbal preparations that can have a positive effect on heart rhythm will be supplemented by the following remedies:

• Valerian. This plant has a pronounced sedative effect, calms uneven heart rhythm and promotes general relaxation, helping to restful sleep. You can buy valerian in different forms. In the pharmacy, the product is presented in the form of tablets, including Forte, as an alcohol tincture, and you can also buy dried roots of the plant and brew it yourself. It is not recommended to take valerian for a long time, as it can itself provoke overexcitation and increased heart rate if it is abused for a long time or the dosage is arbitrarily increased.
• Motherwort. Preparations based on this plant are able to reduce central nervous system excitation, have a sedative and mild hypnotic effect, lower blood pressure and have a moderate cardiotonic effect. They can be used for a long time as additional means or in the form of maintenance therapy, as they do not cause addiction or dependence. Like valerian, motherwort is offered in pharmacies in various forms, including tablets, alcohol tincture and herb.
• Hawthorn. The flowers and fruits of this shrub are good for the heart and have an antihypoxic effect.
• Novopassit. This drug has a pronounced sedative effect and is successfully used for the prevention and treatment of arrhythmia as an adjuvant. It is based on a complex of plant extracts and extracts. Use 1 teaspoon three times a day.
• Persen. Another herbal remedy that contains herbs well known for their calming effect on the nervous and cardiovascular systems. These are peppermint, lemon balm and valerian root. They have a sedative, antispasmodic and antiarrhythmic effect on the body with a minimum number of contraindications and restrictions.

Antiarrhythmic drugs are medications used to normalize the heart rhythm. 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 penetrated by a large number of ion channels through which potassium, sodium, and chlorine ions move. Such movement of charged particles leads to the formation of an action potential. Arrhythmia is caused by abnormal propagation of nerve impulses. To restore the heart rhythm, 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 is reduced.

The choice of antiarrhythmic drug is determined by the type of arrhythmia, the presence or absence of structural heart pathology. If 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 cardiology hospital, where they are given antiarrhythmic drugs intravenously or orally. In the absence of a positive therapeutic effect, move on to. Patients without concomitant chronic heart disease can restore sinus rhythm on their own in an outpatient setting. If attacks of arrhythmia occur rarely, are short and have few symptoms, patients are indicated for dynamic observation.

Classification

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

• 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 relapses of tachyarrhythmias. Medicines in this group coordinate the innervation of the heart muscle.
• Potassium channel blockers - Amiodarone, Sotalol, Ibutilide.
• - “Verapamil”, “Diltiazem”.
• Others: sedatives, tranquilizers, neurotropic drugs have a combined effect on myocardial function and its innervation.

Table: division of antiarrhythmics into classes

Representatives of the main groups and their actions

1A class

The most common drug from the group of class 1A antiarrhythmics is “ Quinidine", which is made from the bark of the cinchona tree.

This medication blocks the penetration of sodium ions into cardiomyocytes, reduces the tone of arteries and veins, has an irritating, analgesic and antipyretic effect, and inhibits brain activity. "Quinidine" has pronounced antiarrhythmic activity. It is effective for various types of arrhythmias, but causes side effects if dosed and used incorrectly. Quinidine has an effect on the central nervous system, blood vessels and smooth muscles.

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

effect of drugs of various classes on the ECG

1B class

Antiarrhythmic class 1B – "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 conductivity of the heart. The medicine stops attacks of ventricular tachycardia in the post-infarction and early postoperative period.

To stop an arrhythmic attack, it is necessary to administer 200 mg of Lidocaine intramuscularly. If there is no positive therapeutic effect, the injection is repeated three hours later. In severe cases, the medicine is administered intravenously as a bolus, 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 remedy in this subgroup is "Ritmonorm" or "Propaphenone". This medicine is intended to treat 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.

2nd grade

Class 2 antiarrhythmics - beta-blockers. Influenced "Propranolol" blood vessels dilate, blood pressure decreases, bronchial tone increases. In patients, the heart rate normalizes, even in the presence of resistance to cardiac glycosides. In this case, the tachyarrhythmic form is transformed into bradyarrhythmic, palpitations and interruptions in cardiac function disappear. The drug can accumulate in tissues, that is, there is a cumulation effect. Because of this, when using it in old age, doses must be reduced.

3rd grade

Class 3 antiarrhythmics are potassium channel blockers that slow down electrical processes in cardiomyocytes. The most prominent representative of this group is "Amiodarone". It dilates coronary vessels, blocks adrenergic receptors, and lowers blood pressure. The drug prevents the development of myocardial hypoxia, reduces the tone of coronary arteries, and reduces heart rate. The dosage for administration is selected only by the doctor on an individual basis. Due to the toxic effect of the drug, its use must be constantly accompanied by monitoring of blood 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, hypertension and arrhythmia. Under the influence of the drug, coronary vessels dilate, coronary blood flow increases, myocardial resistance to hypoxia increases, and the rheological properties of blood are normalized. "Verapamil" accumulates in the body and is then excreted by the kidneys. It is produced in the form of tablets, dragees and injections for intravenous administration. The medicine has few contraindications and is well tolerated by patients.

Other drugs with antiarrhythmic effects

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

1. Anticholinergics, which are used to increase heart rate during bradycardia - "Atropine".
2. Cardiac glycosides intended to slow 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 drugs of plant origin

Medicines of plant origin have an antiarrhythmic effect. List of modern and most common drugs:

Side effects

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

Cardiovascular diseases are a common cause of death, especially among mature and elderly people. Heart disease triggers the development of other life-threatening conditions such as arrhythmia. This is a fairly serious health condition that does not allow for independent 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.

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

Antiarrhythmic drugs

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

Medicines have a positive effect on the body - normalizing the rhythm of contractions allows you to stabilize the functioning 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 medications. If the required positive effect is not recorded, then the patient is recommended to undergo an electrical type of cardioversion.

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

The principle of action of these medications

Antiarrhythmic drugs have a positive effect:

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

Classification

The division of medications is carried out into four main classes, depending on the ability of the drug to conduct electrical impulses. There are several forms of arrhythmic abnormalities, according to which the necessary pharmacological substances are selected.

The main drugs include:

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

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

Table: division of antiarrhythmics into classes

Representatives of the main groups and their actions

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 relapses. Commonly used drugs include Quinidine and Novocainamide.

Quinidine– prescribed in tablet forms. Negative effects on the body when used are presented:

• 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 bloodstream, 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 possible death. Therapy is carried out under the constant supervision of medical personnel and ECG readings.

Quinidine is prohibited for use:

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

Novocainamide– recommended for use based on the same indicators as the previous drug. 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 extreme caution.

The negative impact of the drug is represented by:

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

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

A pharmacological substance can provoke allergic reactions - the initial symptomatic manifestation of the problem is 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, atria and atrioventricular junction.

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

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

• convulsive conditions;
• periodic dizziness;
• decreased visual acuity;
• problems with intelligible speech;
• disturbances in clarity of consciousness;
• rashes on the skin;
• hives;
• Quincke's edema;
• 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 - even arrhythmic deviations.

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

1C class

These pharmacological substances can prolong intracardiac conduction time. Against the background of pronounced arrhythmogenic effectiveness, medications have received restrictions on their use. The main representative of the subgroup is Ritmonorm.

The medicine is necessary to suppress the negative symptomatic manifestations of ventricular or supraventricular arrhythmia. When taken, there is a high risk of developing an arrhythmogenic effect; therapy is carried out under the constant supervision of a medical professional.

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

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

2nd grade

A large amount of adrenaline produced is recorded when the functionality of the sympathetic nervous department increases - in stressful situations, autonomic abnormalities, arterial hypertension, ischemic damage to the heart muscle.

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

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

Medicines 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 directly related to an excess amount of hormones in the bloodstream. The use of Anaprilin and Metoprolol is recommended as the main means of treatment.

The negative effects of the above medications include a decrease in the level of contractility of muscle tissue, a slowdown in heart rate, and the formation of atrioventricular block. Pharmacological substances can significantly impair the functionality of the circulatory system and cause a decrease in the temperature of the lower and upper extremities.

The use of Propranolol can provoke a deterioration in bronchial conduction - the 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 levels in the bloodstream.

Medicinal substances can have an effect on the nervous system - provoke spontaneous dizziness, disturbances in night sleep, decreased memory, and cause depression. Medicines disrupt the conductivity of the neuromuscular compartment, manifesting itself in the form of increased fatigue, weakness, and decreased muscle tone.

In some cases, rashes on the skin, persistent itching and focal baldness may appear. In males, erectile dysfunction may occur, and blood counts may show thrombocytopenia and agranulocidosis.

When suddenly discontinued, drugs cause pathological conditions:

• anginal attacks;
• disturbances in the rhythm of the heart muscle at the level of the ventricles;
• increased blood pressure;
• increased heart rate;
• decreased level of exercise tolerance.

The withdrawal of medications is carried out in stages, over two weeks. Beta-blockers are prohibited for use in cases of insufficient organ functionality, swelling of the lung tissue, cardiogenic shock conditions, and in severe cases of chronic failure of the heart muscle. Their use is also not recommended for diabetes mellitus, sinus bradycardia, a drop in systolic pressure below 100 units, and bronchial asthma.

3rd grade

The drugs are antagonists of potassium channels, slowing down electrical processes in the cellular structures of the heart muscle. Amiodarone is a frequently prescribed drug in this subgroup.

The drug gradually accumulates in tissue structures and is released at the same speed. Maximum effectiveness is recorded three weeks from 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 due to Wolff-Parkinson-White pathology;
• to prevent ventricular arrhythmias during acute myocardial infarction;
• for persistent atrial fibrillation - to suppress the frequency of contractions of the heart muscle.

Long-term and uncontrolled use of the medication can provoke:

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

The drug is toxic to the fetus. Prohibited use are:

• initial type of bradycardia;
• pathologies of intracardiac conduction;
• hypotension;
• bronchial asthma;
• diseases affecting the thyroid gland;
• period of gestation.

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

4th grade

Drugs can block the passage of calcium ions, reducing the automatic reactions of the sinus node and suppressing pathological foci in the atrium. 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 supraventricular tachycardia and extrasystole. The drug is necessary to suppress the frequency of ventricular contractions during 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 medication are expressed:

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

Prohibitions on the use of the drug are:

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

Other drugs with antiarrhythmic effects

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 contraction of the organ;
• anticholinergics - 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 disturbances in electrolyte metabolism, a liquid protein diet and prolonged exposure to certain antiarrhythmic drugs.

Herbal products

Healing plants are quite effective means for treating the pathological process. They are included in certain medications and are officially recognized by medicine. Stabilization of heart rate indicators is carried out:

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 make a home form of the drug, but it is freely sold in pharmacy chains and the long preparation process does not make logical sense.
2. Valerian - it can be found on the open market in the form of tinctures, tablets, and herbal raw materials. The healing substance helps suppress painful sensations, restore the rhythm of contraction of the heart muscle, and has a calming effect. If long-term therapy is necessary, 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. The additional effect of the drug is to relieve psycho-emotional stress, suppress constantly present irritability, and treat nervous fatigue.

What is most often prescribed for various types of arrhythmias?

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

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

Combination of antiarrhythmic drugs

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

Together with beta-blockers, the drug 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 efficiency rates for tachyarrhythmias, focal tachycardias, and ventricular extrasystoles.

Side effects

Medicines 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 drowsiness;
• lowering blood pressure levels;
• double vision of objects before the eyes;
• sudden stop of respiratory function;
• insufficient kidney function;
• dyspeptic disorders;
• bronchospasm;
• problems with urination;
• increased dryness of the oral mucous membranes;
• allergic reactions;
• drug fever;
• leukopenia;
• thrombocytopenia.

ANTIARRYTHMIC DRUGS (syn. antiarrhythmic drugs) - a group of drugs used to prevent and relieve cardiac arrhythmias.

P.S. according to the classification proposed in 1971-1972. Singh and Williams (V.N. Singh, V.E.M. Williams), are divided into 4 groups.

The first group includes drugs with membrane-stabilizing properties: quinidine (see), novocainamide (see), disopyramide (syn. rhythmodan), ajmaline (see), etmozin, see), mexitil, lidocaine, trimecaine (see) and diphenin (see). In the concentrations necessary to detect an antiarrhythmic effect, they have a comparable effect on the Electrophysiological characteristics of myocardial fibers. Drugs in this group have the ability to reduce the maximum rate of depolarization of myocardial cells due to dysfunction of the so-called. fast sodium channels of the cell membrane. At therapeutic concentrations, this effect is manifested by an increase in the threshold of excitability, inhibition of conductivity and an increase in the effective refractory period. In this case, there is no significant change in the resting potential of the cell membrane and the duration of the action potential, but suppression of spontaneous diastolic depolarization of cells of the conduction system of the heart is constantly recorded.

Therapeutic effect of P. s. This group is observed in arrhythmias (see Cardiac Arrhythmias), which arise as a result of the circulation of an excitation wave in a closed CIRCLE as a result of a change in the effective refractory period, and in arrhythmias, which are based on a mechanism of increased automatism or a decrease in the threshold of excitability, as a result of suppression of spontaneous diastolic depolarization.

Second group P. s. includes propranolol (see) and other β-blockers, which have an anti-arrhythmic effect. arr. due to the blockade of sympathetic influences on the heart through β-adrenergic receptors. β-adrenergic receptor blockers, by suppressing the activity of adenylate cyclase of cell membranes, inhibit the formation of cyclic AMP, which is an intracellular transmitter of the effects of catecholamines, which are involved under certain conditions in the genesis of arrhythmias. Electrophysiologically, the effect of drugs of this group in therapeutic doses is characterized by inhibition of the fourth phase of depolarization. However, the significance of this phenomenon in the mechanism of their antiarrhythmic action is still unclear. β-Blockers increase the duration of the action potential of myocardial cells.

Third group P. s. represented by amiodarone (cordarone) and ornid (see). Amiodarone moderately inhibits sympathetic innervation, but does not interact with β-adrenergic receptors. In experimental studies, it was shown that amiodarone does not have a membrane-stabilizing effect and has extremely weakly expressed properties inherent in the first group of P. s.

Ornid has an antiarrhythmic effect, the mechanism of which remains unclear. It is believed that it is due to the inhibitory effect of this drug on the release of norepinephrine from the endings of the sympathetic nerves.

In the fourth group P. s. includes inhibitors of transmembrane transport of calcium ions. The most active is verapamil (see). Using electrophysiological research methods, it has been established that it causes a prolongation of the 1st and 2nd phases of the action potential due to the blockade of calcium channels in the cell membrane, which is accompanied by an antiarrhythmic effect. This is evidenced by experimental data on the role of disturbances in slow calcium current through the membranes of myocardial cells in the genesis of certain types of arrhythmias. With such arrhythmias, an ectopic focus appears as a result of activation of the ionic mechanism of the “slow response” type, which is normally characteristic of the cells of the sinus and atrioventricular nodes. It is assumed that this mechanism is involved in the occurrence of arrhythmias associated both with the circulation of the excitation wave and with increased automaticity.

Thus, the antiarrhythmic effect can be obtained as a result of the effect of antiarrhythmic drugs on various electrophysiological properties of myocardial cells.

In terms of effectiveness for various forms of arrhythmias among P. s. we can highlight those that are predominantly effective for supraventricular arrhythmias (eg, verapamil), ch. arr. for ventricular arrhythmias (lidocaine, trimecaine), for supraventricular and ventricular arrhythmias (ajmaline, quinidine, novocainamide, disopyramide, etc.).

When determining indications for P.'s appointment. The form of the arrhythmia, the nature of the underlying disease, the conditions that contributed to the occurrence of the arrhythmia, as well as the nature and characteristics of the action of the drugs should be taken into account.

Verapamil prescribed for supraventricular extrasystoles and supraventricular paroxysmal tachycardias resulting from the circulation of an excitation wave in the sinoatrial region, atria, and atrioventricular node. However, in patients with ventricular preexcitation syndrome, in which, during a paroxysm of tachycardia (especially atrial fibrillation), impulses in the anterograde direction are conducted along the Kent bundle, verapamil can, by improving conductivity, worsen the course of the arrhythmia.

Application lidocaine and trime-caine is limited to the parenteral administration of these drugs to suppress ventricular arrhythmias in acute myocardial infarction, cardiac surgery, and intoxication with cardiac glycosides. In the case of arrhythmias associated with hypokalemia, these drugs are ineffective. Lidocaine sometimes also has a stopping effect in case of supraventricular tachycardia, in which additional pathways are included in the circulation of the excitation wave.

Difenin appoint Ch. arr. for ventricular arrhythmias arising from intoxication with cardiac glycosides and hypokalemia. Patients with severe heart failure and impaired atrioventricular conduction are usually prescribed only lidocaine (in small doses) or diphenine; most P. s. they are contraindicated.

In case of heart failure without conduction disturbances, in addition to these drugs, ethmosin and amiodarone can also be prescribed.

In case of bradytachycardia syndrome (sick sinus syndrome), the use of disopyramide, quinidine, verapamil or β-adrenergic receptor blockers can lead to an increase in the duration of asystole, and therefore they should be prescribed with caution.

Particular care is required in P.'s choice of s. for patients with additional pathways of excitation in the anterograde direction along the Kent bundle. This is explained by the fact that certain drugs from among P. s. stop attacks of arrhythmia, but are able to prevent their occurrence. In addition, some P. s. may contribute to the occurrence of tachycardia. Thus, in patients with Wolff-Parkinson-White syndrome and wide ventricular complexes during paroxysm, the use of glycosides or verapamil can lead to improved conduction along the Kent bundle, and in case of atrial flutter or fibrillation, cause ventricular fibrillation. In such cases, it is recommended to prescribe lidocaine, procainamide, ajmaline or amiodarone to stop the attack.

For nodal atrioventricular paroxysmal tachycardia, it is most advisable to use verapamil, obzidan, amiodarone, as well as cardiac glycosides that have the ability to slow down the rate of excitation in the atrioventricular node. For such arrhythmias, novocainamide and quinidine are ineffective, since they do not affect conduction in this node. However, novocainamide and quinidine can be used to prevent attacks, since they suppress extrasystole, which, under certain conditions, is a trigger factor in the occurrence of tachycardia paroxysm.

To relieve atrial fibrillation, intravenous administration of novocainamide, ajmaline, and amiodarone is recommended; if the attack is well tolerated, quinidine, disopyramide or procainamide are prescribed orally in appropriate doses. Verapamil and cardiac glycosides are used only to slow down the ventricular rhythm.

In patients with ventricular tachycardia, the most effective method for interrupting an attack is lidocaine, which, if necessary, can be prescribed in the maximum therapeutic dose (until the appearance of moderate symptoms from the central nervous system). If there is no effect from lidocaine, other drugs are used (taking into account contraindications).

Treatment tactics for P. s. determined by the severity of the disease and the prognostic value of existing heart rhythm disturbances. There is no doubt about the need for the prevention of continuous use of drugs for frequently recurring (several times a week) paroxysms, frequent extrasystoles, accompanied by severe hemodynamic disturbances and poor health, causing loss of ability to work or threatening life. Patients with rare attacks of tachycardia (tachyarrhythmia) or with relatively frequent attacks that occur without a sharp disturbance in the general condition and are easily stopped can be recommended to take P. s. only for the purpose of interrupting them.

The doctor's tactics in the treatment of patients with extrasystoles that are asymptomatic or with minor wedge manifestations are determined by the prognostic value of extrasystoles. Prospective observations have shown that in practically healthy individuals, supraventricular or ventricular extrasystoles are not life-threatening, therefore, the accidental detection of an asymptomatic cardiac arrhythmia in them (without heart disease) should not serve as an indication for the use of P. s. At the same time, with chronic coronary heart disease, ventricular extrasystoles significantly worsen the prognosis for life, and therefore patients should be prescribed drugs that have antianginal and antiarrhythmic effects.

There is data indicating the possibility of development in some cases of the arrhythmogenic effect of all active P. s. In this regard, for Wolff-Parkinson-White syndrome, ventricular tachycardia and ventricular fibrillation, individual selection of P. with. using acute drug tests (intravenous or oral administration of P. s. starting with small doses that are adjusted to the maximum permissible) under careful electrocardiographic control at rest and during physical activity or against the background of an artificially imposed heart rhythm, which allows timely detection of the arrhythmogenic effect of P. . With. and, if necessary, provide emergency assistance.

If there is no effect from prescribing any one drug, combinations of P. with. from various groups. The most rational is the simultaneous administration of beta-blockers with quinidine or cardiac glycosides. However, it is not recommended to combine P. with., having the same mechanism of action or having the opposite effect on the Electrophysiological properties of the myocardium and the conduction system of the heart.

Clinical and pharmacological characteristics of the main P. s. is given in the table.

Name of the drug (Russian and Latin) and main synonyms (typed in italics and published as separate articles)

Therapeutic doses and methods of administration

Indications for use for arrhythmias

to relieve attacks

for the prevention of arrhythmias

Absolute and relative contraindications

Release forms and storage

Causes moderate hypotension, slightly increases coronary blood flow, and has a moderate adrenolytic effect. Reduces myocardial excitability, lengthens the refractory period, slows down atrioventricular and intraventricular conduction, and inhibits the automatism of the sinus node.

The antiarrhythmic effect develops in the first minutes after intravenous administration. Duration of action is 6-8 hours.

Intravenous 2-3 ml of 2.5% solution for 7-10 minutes. or orally 0.05 - 0.1 g

Orally 0.05 - 0.1 g 3-4 times a day

Hypotension, nausea, adynamia, feeling of heat

Conduction disturbances, heart failure, hypotension

Tablets 0.05 g; 2.5% solution in ampoules of 2 ml.

Amiodarone; synonym: cordarone, Cordarone, Trangorex, etc.

Causes moderate expansion of peripheral and coronary vessels. Reduces pre- and afterload on the heart, as well as its work. It has a moderately pronounced sympatholytic effect and leads to a slight decrease in pulse rate and blood pressure. Extends the effective refractory period of the atria and ventricles, slows down the conduction of the atrioventricular node.

The antiarrhythmic effect when administered intravenously develops within a few minutes and reaches a maximum after 15 minutes. and continues approx. 30 min. When taken orally, the duration of action is several days.

Over ventricular and ventricular arrhythmias

Intravenously at a rate of 5 mg/kg

Orally according to the following scheme: the first week, 1-2 tablets 3 times a day, the second week, 1-2 tablets 2 times a day, then 1-2 tablets in courses lasting 5 days with a two-day break between courses

Decreased appetite, nausea, constipation, decreased thyroid function, allergic reactions.

In case of overdose, bradycardia may develop

Severe bradycardia, sick sinus syndrome, stage II-III heart block, hypotension, bronchial asthma, thyroid dysfunction, pregnancy

Tablets of 0.2 g; ampoules containing 0.15 g of the drug.

Dilates coronary and peripheral arteries. When administered intravenously, it short-term worsens myocardial contractility and reduces blood pressure. Reduces spontaneous activity of the sinus node, slows down atrioventricular conduction, suppresses ectopic activity in the atria and atrioventricular node.

The antiarrhythmic effect after intravenous administration reaches a maximum after 3-5 minutes. and lasts 4-7 hours; when taken orally, it develops after 1 hour and reaches a maximum after 3-5 hours.

Intravenously 4 ml (sometimes 6-8 ml) 0.25% solution at a rate of 0.5 - 1 ml/min or orally 0.04-0.12 g (sometimes up to 0.16 g)

Orally 0.04 g (in severe cases 0.08 g) 3-4 times a day

Headache, itching, constipation, hypotension, atrioventricular conduction disturbances

Heart failure, atrioventricular conduction disorders, sick sinus syndrome, hypotension, therapy with beta-blockers; Wolff-Parkinson-White syndrome with atrial fibrillation

Tablets 0.64 g; 0.25% solution in ampoules of 2 ml.

Storage: sp. B.; in a place protected from light

Disopyramide; synonym: rhythmodan, Rythmodan

It has moderate hypotensive and anticholinergic effects. Inhibits myocardial contractility. Reduces excitability and slows myocardial conduction, lengthens the effective refractory period.

The antiarrhythmic effect develops after 30-40 minutes. after ingestion. Duration of action approx. 4-6 hours

Supraventricular and ventricular arrhythmias

Orally 0.1 -0.2 g 3-4 times a day

Hypotension, tachycardia, nausea, vomiting, dry mouth, urinary retention, constipation, visual acuity disorders

Heart failure, stage II-III atrioventricular conduction block, sick sinus syndrome, hypotension, individual intolerance

Tablets 0.1 and 0.2 g.

Has anticonvulsant effect. When administered rapidly intravenously, it causes a decrease in peripheral resistance, a decrease in cardiac output and hypotension. Increases coronary blood flow. Reduces atrioventricular block caused by glycosides; exhibits antiarrhythmic activity in conditions of hypokalemia. Shortens the duration of the effective refractory period and increases the speed of excitation.

The duration of the antiarrhythmic effect after oral administration is 6-12 hours; the maximum effect develops on the 3-5th day of taking the drug

Orally during or after meals, 0.1 g 3-4 times a day (for slow “saturation”) or 0.2 g 5 times a day (for quick “saturation”)

Dizziness, ataxia, nystagmus, dysarthria, loss of appetite, hepatitis, anemia, skin rash, etc.

Severe heart failure, liver damage, hypotension

Tablets of 0.117 g of a mixture of diphenylhydantoin and sodium bicarbonate in a ratio of 85: 15 (each tablet corresponds to 0.1 g of diphenine).

Storage: sp. B; in a well-closed container, protected from light

Lidocaine (Lidocaine Hydrochloride); synonym: xylocaine, xycaine, Lidocaini Hydrochloridum, Lignocain, Xylocard, Xylocitin, etc.

Has a local anesthetic effect. Affects the conduction of impulses in the affected ventricular myocardium and in additional conduction pathways, does not affect the Electrophysiological characteristics of the atrial myocardium.

The antiarrhythmic effect develops in the first minutes from the start of intravenous administration

Intravenous* bolus 4-6 ml of 2% solution for 3-5 minutes. or 10 ml of 2% solution for 5-10 minutes.

If necessary, the administration is repeated

Intravenously, first 4-6 ml of 2% solution in a stream, then drip in 5% glucose solution at a rate of 2-3 ml/min; in 10-15 minutes. From the beginning of the drip administration, 2-3 ml of 2% solution are injected repeatedly. Intramuscularly, 4-6 ml of 10% solution every 3 hours

Dizziness, numbness of the tongue, lips, drowsiness, adynamia.

With rapid intravenous administration, hypotension and collapse may develop.

Intolerance to drugs such as novocaine, severe heart failure, hypokalemia

2 and 10% solution in ampoules of 2 ml.

Storage: sp. B; in a place protected from light

Mexitil; syn. mexiletine

It has a moderate local anesthetic and anticonvulsant effect. If conduction is initially impaired, it may increase its severity. When administered intravenously, it reduces cardiac output and peripheral resistance.

The antiarrhythmic effect develops when administered intravenously in the first minutes after administration, when taken orally - after 1 - 2 hours. Duration of action approx. 6-8 hours

0.075-0.25 g for 5-15 minutes. Orally 0.3-0.4 g; if necessary up to 0.6 g

Orally 0.2-0.4 g 3-4 times a day

Dizziness, nystagmus, difficulty speaking, nausea, vomiting, tremor, hypotension

Hypotension, severe heart failure, sinus node weakness, severe intraventricular conduction disturbances

Storage: sp. B; in a place protected from light

It has a local anesthetic effect, inhibits excitability, conductivity and, to a lesser extent, myocardial contractility. When administered intravenously, it causes a hypotensive effect. Suppresses ectopic activity in the atria and ventricles.

When taken orally, the maximum antiarrhythmic effect develops through

Supraventricular and ventricular arrhythmias

Intravenous 5-10 ml of 10% solution at a rate of 1-2 ml for 2 minutes.

Intravenous drip at the rate of 2-3 ml/min. Intramuscularly, 5 - 10 ml of 10% solution (up to 20 - 30 ml per day). Orally 0.25 - 0.5 g every 4 hours (daily dose)

Nausea, vomiting, diarrhea, hallucinations, lupus nocturnal syndrome.

In case of overdose and increased individual sensitivity, cardiac depression is possible

Violation of atrioventricular and intraventricular conduction, heart failure, increased individual sensitivity to novocaine

Tablets 0.25 g; 10% solution in hermetically sealed bottles of 10 ml and ampoules of ■ 5 ml.

Storage: sp. B; in a place protected from light

1-2 hours. Duration of action approx. 3-4 hours

Has a sympatholytic effect. Inhibits the release of norepinephrine from the endings of sympathetic nerves, reducing the influence of sympathetic innervation on effector organs. Reduces myocardial excitability and contractility, slows conduction, and lengthens the refractory period.

The antiarrhythmic effect with parenteral administration develops after 20-40 minutes. Duration of action approx. 8 o'clock

Intravenously at the rate of 0.1 ml of 5% solution per 1 kg of body weight (weight) for 10-15 minutes.

for no more than 4 g)

Intramuscularly or subcutaneously 0.5-1 ml of 5% solution 2-3 times a day

Hypotension, adynamia, dyspeptic disorders, temporary visual impairment

Hypotension, cerebrovascular accidents

Ampoules of 1 ml 5% solution.

Storage: sp. B; in a place protected from light

Blocks β-adrenoreceptors. Reduces the force of heart contractions, slows the pulse, lengthens the period of systole, reduces systolic volume and cardiac output, reduces the volumetric velocity of coronary blood flow, and reduces myocardial oxygen demand. Reduces blood pressure, increases total peripheral resistance and bronchial muscle tone. Suppresses glycogenolysis and lipolysis. Reduces myocardial excitability, suppresses automatism, eliminates the ability of catecholamines to shorten the refractory period.

The antiarrhythmic effect develops maximally after 5 minutes. after intravenous administration and 1-2 hours after oral administration. Duration of action when administered intravenously is approx. 2-4 hours, when taken orally, approx. 3-6 hours

Supraventricular and ventricular arrhythmias

Intravenously, 1-2 ml of 0.1% solution every 2 minutes. up to a total dose of 5-10 ml. Orally 0.08-0.16 g

Inside in 15-30 minutes. before meals starting with a dose of 0.02 g

3-4 times a day; gradually the daily dose is increased to 0.2-0.3 g per

Hypotension, nausea, vomiting, adynamia, cold hands and feet, intermittent claudication, bronchospasm, allergic reactions

Bronchial asthma, heart failure, severe bradycardia, sick sinus syndrome, hypotension, intermittent claudication, hypoglycemia, atrioventricular block, peptic ulcer, hypothyroidism

Tablets of 0.01 and 0.04 g; ampoules of 1 and 5 ml of 0.1% solution.

Storage: sp. B; in a place protected from light

Quinidine sulfate (Chinidini sulfas); synonym: Chinidinum sulfuricum, Quinidi-ni Sulfas, etc.

It has a moderate anticholinergic and negative inotropic effect. It has a local anesthetic and vasodilator effect, slows down sinoatrial and intraventricular conduction. Increases the threshold of chemical and electrical fibrillation of the atria and ventricles, lengthens the refractory period of the heart.

The antiarrhythmic effect develops 2-3 hours after oral administration. Duration of action is 4-6 hours.

Orally 0.2-0.4 g 4-6 times a day

Nausea, diarrhea, abdominal pain, hearing loss, vision impairment, thrombocytopenia, anemia, agranulocytosis, allergic reactions.

In case of overdose, cardiac depression may occur

Heart failure, stage III atrioventricular block, hypotension, saturation with cardiac glycosides, increased individual sensitivity

Tablets 0.1 g.

Storage: sp. B; in a place protected from light

It has a certain coronary dilatation, antispasmodic and anticholinergic activity, and has almost no effect on the inotropic function of the myocardium. Slows conduction, lengthens the effective refractory period and reduces the excitability of the heart muscle

Intravenous 4-6 ml of 2.5% solution over 5-7 minutes.

Orally 0.2 g 3-4 times a day

Noise in the head, dizziness, numbness of the tip of the tongue, lips, nausea, abdominal pain, itching

Conduction disorders, liver and kidney dysfunction, hypotension

Film-coated tablets, 0.1 g; 2 ml ampoules of 2.5% solution.

Storage: sp. B; in a place protected from light

Bibliography: Mazur N. A. Current state and prospects for studying cardiac arrhythmias, Cardiology, v. 18, no. 4, p. 5, 1978; aka, Questions of terminology, classification of cardiac arrhythmias and tactics of their treatment, Bull. All-Union cardiol. scientific Center of the USSR Academy of Medical Sciences, vol. 3, no. 2, p. 8, 1980; Sumarokov A.V. and Mikhailov A.A. Cardiac arrhythmias, M., 1976; H a z about in E. I. and Bogolyubov V. M. Heart rhythm disturbances, M., 1972; Krone R. J. a. K 1 e i g e g R. E. Prevention and treatment of supraventricular arrhythmias, Heart a. Lung, v. 6, p. 79, 1977; Opie L. H. Drugs and the heart, Lancet, v. 1, p. 861, 1980; Rosen M. R. a. Hoffman B. F. Mechanisms of action of antiarrhythmic drugs, Circulat. Res., v. 32, p. 1, 1973; Singh B. N. a. Vaughan Williams E. M. Effect of altering potassium concentration on the action of lidocaine and diphenylthydantoin on rabbit atrial and ventricular muscle, ibid., v. 29, p. 286, 1971; are they A fourth class of anti-dysrhythmic action? Effect of verapamil on ouabain toxicity, on atrial and ventricular intracellular potentials, and on other features of cardiac function, Cardiovasc. Res., v. 6. p. 109, 1972; Singh B. N.. Collett J. T. a. Chew Ch. Y. C. New perspectives in pharmacologic therapy of cardiac arrhythmias, Progr. cardiovasc. Dis., v. 22, p. 243, 1980; Winkle R. A., G I a n t z S. A. a. Harrison D. C. Pharmacologic therapy of ventricular arrhythmias, Amer. J. Cardiol., v. 36, p. 629.1975.

Antiarrhythmic drugs: classification and description

Antiarrhythmic drugs are a group of drugs prescribed to normalize heart rhythm. Such compounds of chemical elements have their own classification. These medications are intended to treat tachyarrhythmia and other manifestations of this disease, and also prevent the development of heart rhythm disturbances. The use of antiarrhythmic drugs does not increase the overall life expectancy of the patient, but only helps control some symptoms of the disease.

Varieties

The drugs are necessary for patients who have been diagnosed with a failure of the contractile function of the main organ for pathological reasons. This condition threatens a person’s life and worsens its quality. An antiarrhythmic drug can have a positive effect on the patient’s entire body and stabilize the activity of all systems and organs. You should take such tablets only as prescribed by a doctor and under the supervision of diagnostic measures, such as an ECG.

There is such a concept in medicine as “innervation of the heart,” which suggests that the activity of the organ is constantly controlled by the endocrine and nervous system. The organ is equipped with nerve fibers that regulate its function; if there is an increase or decrease in the frequency of contractions of this department, then the cause is often sought in disorders of the nervous or endocrine system.

Antiarrhythmic drugs are necessary to stabilize sinus rhythm; this is a critical part of therapy. Often the patient is treated in a hospital setting, with drugs of this effect administered intravenously. When no concomitant pathologies of the cardiovascular system have been identified, a person’s condition can be improved on an outpatient basis by taking pills.

The classification of antiarrhythmic drugs is based on the ability of such medications to influence the production and normal conduction of electrical impulses in cardiomyocytes. The division is carried out according to classes, of which there are only four. Each class has a specific path of influence. The effectiveness of drugs for different types of heart rhythm disturbances will vary.

Type of medicine and description:

1. Beta blockers. This group of drugs can influence the innervation of the heart muscle, controlling it. This drug reduces the mortality of patients from acute coronary insufficiency, and can also prevent relapse of tachyarrhythmia. Medicines: Metaprolol, Propranolol, Bisoprolol.
2. Membrane-stabilizing sodium channel blockers. The indication for the use of this medicine is to impair the functionality of the myocardium. Medicines: Lidocaine, Quinidine, Flecaidine.
3. Calcium antagonists. A drug of this group has an effect that reduces the tone of the sympathetic nervous system and also reduces the need for oxygen by the myocardium. Medicines: Diltiazem, Verapamil.
4. Calcium channel blockers. The principle of the influence of these drugs on the body is based on reducing the excitability of the heart and reducing the automatism of the myocardium. In addition, the drug slows down the conduction of nerve impulses in parts of the organ. Medicines: Ibutilide, Amiodarone, and Sotalol.
5. Additional means, the mechanism of action of which is different. Neurotropic drugs, tranquilizers, cardiac glycosides and others.

The classification of antiarrhythmic drugs varies, but doctors often classify such drugs according to Vogen-Williams. What kind of medicine is needed for a particular patient depends on the cause of the heart rhythm disorder.

It is impossible to choose the right antirhythmic without the help of a doctor. The properties of drugs are known only to specialists; each of the representatives of such drugs can harm a person if taken without a doctor’s prescription.

Characteristics of 1st class

The mechanism of action of such medications is the ability of certain chemicals to block sodium channels, as well as reduce the speed of action of an electrical impulse in the myocardium. Arrhythmia is often characterized by a violation of the movement of the electrical signal; it spreads in a circle, which provokes the heart to beat more often, in the absence of control over this process of the main sinus. Drugs that block sodium channels help normalize this mechanism.

The first class of drugs is distinguished by a large group of antiarrhythmic drugs, which is divided into subclasses. All these branches have almost the same effect on the heart, reducing the rate of its contractions within a minute, but each individual representative of such drugs has its own characteristics, which only specialists know for sure.

Description of class 1A products

In addition to sodium, such medications can block potassium channels. A good antiarrhythmic effect complements a strong analgesic effect. These medications are prescribed for supraventricular and ventricular extrasystole, atrial fibrillation, and tachycardia.

The main representative of such drugs is “Quinidine”; it is used more often than others in treatment. It is convenient to take the drug; it is available in tablet form, but there are side effects and contraindications to therapy with this medication. Due to the high toxicity of such drugs, and a large number of negative reactions of the body during treatment, these representatives of class 1A are used only to relieve an attack. Further use is carried out using drugs of other types.

Class 1B drugs

The use of medications in this group is justified when there is a need not to inhibit (suppress) potassium channels, but to activate them. They are prescribed mainly for disorders in the ventricles of the heart, namely extrasystole, tachycardia or paroxysm. Usually the drug is administered intravenously, but such drugs already exist in the form of tablets.

The effect of these drugs on the human body makes it possible to use them even in the case of myocardial infarction. Side effects from taking the medication are minor and usually manifest themselves as disorders of the nervous system, inhibiting its function. Cardiac complications are practically not observed.

Of the entire list of such drugs, the most famous is Lidocaine, which is often used and can serve as an anesthetic in other areas of medicine. It is noteworthy that if you take the medication, its effect will be very weak, almost imperceptible. Intravenous infusions have the opposite effect, manifesting themselves in pronounced antiarrhythmic effects on the human body. Lidocaine is known to often cause allergic reactions, so you should be careful when using this product.

Class 1C drugs

Representatives of this subgroup are the most powerful drugs that block calcium and sodium ions. The effect of such medications extends to all areas of electrical impulse transmission, starting from the region of the sinus node. They are usually used in treatment as tablets for oral administration. Drugs in this group have a wide range of effects on the body and are highly effective against tachycardia of various natures, atrial fibrillation and other heart pathologies. Therapy can be carried out both to quickly stop an attack, and as a permanent treatment for ventricular or supraventricular arrhythmia. If any organic damage to the heart is detected, medications in this group are contraindicated.

It should be noted that all class 1 drugs have limitations for the treatment of people with severe heart failure, scars on the organ, other changes and tissue pathologies. Statistics show that among patients who have such disorders, treatment with such drugs has increased the mortality rate.

The latest generation of antiarrhythmic drugs, called beta blockers, are significantly different in all respects from representatives of the class 1 group of medications; they are much safer and more effective.

Description of class 2 products

The chemicals contained in such medications slow down the heart rate in various diseases of this organ. Indications for use are usually atrial fibrillation, some types of tachycardia, and ventricular fibrillation. In addition, these drugs help to avoid the harmful effects of emotional disorders on the course of the disease. Catecholamines, namely adrenaline, produced in increased quantities, can negatively affect the rhythm of the heart, causing increased contraction of the organ. With the help of class 2 medications, it is possible to avoid negative manifestations in such situations.

The drugs are also prescribed to people who are in a state after a myocardial infarction; this improves the functioning of the cardiovascular system and also reduces the risk of death. It is important to consider that drugs in this group have their own contraindications and side effects.

Long-term use of such medications can adversely affect the sexual function of men, as well as cause disturbances in the bronchopulmonary system and increase the amount of sugar in the blood. Among other things, beta blockers are completely contraindicated for bradycardia, low blood pressure and any form of heart failure. Doctors record significant depression of the central nervous system; if a patient takes such pills for a long time, depressive disorders may occur, memory may deteriorate and the musculoskeletal system may weaken.

Class 3 medications

Drugs in this group are distinguished by the fact that they prevent charged potassium atoms from entering the cell. Such medications do not slow down the rate of heartbeat much, unlike representatives of class 1 medications, but they are able to stop atrial fibrillation, which lasts for a long time, weeks and months. In such a situation, other means are usually powerless, so doctors resort to prescribing class 3 drugs.

Among the side effects, there are no such effects in relation to heart rhythm, and as for the negative impact on other parts of the body, doctors are able to control it during the treatment period. When prescribing such medications, the peculiarities of their combination with drugs of various groups must be taken into account.

These medications should not be taken simultaneously with cardiac medications, antirhythmics with other effects, diuretics, antibacterial medications from the macrolide category, as well as with anti-allergy medications. When cardiac disorders occur, as a result of improper combination of medications, sudden death syndrome may develop.

Class 4 mechanism of action

These drugs reduce the amount of charged calcium atoms entering cells. This affects many parts of the cardiovascular system, as well as the automatic function of the sinus node. At the same time expanding the lumen of blood vessels, such drugs can lower blood pressure and reduce the number of organ beats per minute. In addition, this effect prevents the formation of blood clots in the arteries.

Class 4 drugs help correct antiarrhythmic disorders in myocardial infarction, angina pectoris, and arterial hypertension. Doctors prescribe such medications with caution if the patient is diagnosed with atrial fibrillation accompanied by SVC syndrome. Side effects include bradycardia, blood pressure well below normal, and circulatory failure. These antiarrhythmic drugs can be taken about twice a day, as they have a prolonged effect on the body.

Other antirhythmics

The Vogen-Williams classification does not include other drugs that have an antiarrhythmic effect. Doctors combined such drugs into a class 5 group. Such medications can reduce the rate of heart contractions and also have a beneficial effect on the entire cardiovascular system. The mechanism of influence on the human body is different for all these drugs.

Representatives of Group 5 funds:

Cardiac glycosides exert their effects based on the properties of naturally occurring cardiac poisons. If the dosage of the drug is selected correctly, the therapeutic effect of taking it will be positive, and the activity of the entire cardiovascular system will be restored. Such medications are prescribed for attacks of tachycardia, manifestations of heart failure, atrial flutter and fibrillation by slowing the conduction of the nodes. It is often used as a replacement for beta-blockers when taking them is impossible.

Cardiac glycosides:

Exceeding the permissible doses can negatively affect the activity of the heart and cause a specific type of intoxication.

Sodium, potassium and magnesium salts can compensate for the lack of important minerals in the body. In addition, these drugs change the level of electrolytes and help remove excess of other ions, especially calcium. Often, such drugs are prescribed instead of antiarrhythmic drugs of groups 1 and 3.

These medications are used in medicine to prevent certain disorders of the cardiovascular system.

"Adenazine" is often used as an ambulance for attacks of sudden paroxysm. Usually the drug is administered intravenously and several times in a row, due to the short period of exposure. Prescribed to maintain the course of therapy and for prophylactic purposes in the treatment of any heart pathologies.

Ephedrine is the complete opposite of beta blocker drugs. This remedy increases the sensitivity of receptors and also has a stimulating effect on the central nervous system, blood vessels and heart. Long-term use of this medication is not recommended by doctors; more often the medicine is used as an emergency aid.

Herbal antirhythmic drugs

Arrhythmia requires a serious approach to therapy; doctors usually prescribe medications of chemical origin, but herbal remedies also occupy not the least place. Such medications have virtually no contraindications or side effects, and are therefore considered safer. However, you cannot start taking such medications on your own; you need to coordinate this with your doctor.

These medications contain only natural herbal ingredients. Treatment with only such drugs has a weak therapeutic effect, but can serve as an auxiliary method to enhance the properties of other drugs. The calming effect also allows you to reduce the heart rate, as well as help a person survive an attack of arrhythmia without panic.

Among the body's adverse reactions to these drugs, allergic manifestations that occur to plant components can be distinguished. Contraindications for use are bradycardia and low blood pressure. Before using infusions and decoctions of any herbs, you must consult a doctor, because even such harmless representatives of nature can have a negative effect on the body.

Antiarrhythmic drugs today are quite varied, but choosing the right drug is not easy. Medicine does not stand still and the latest generation of medicines are already being developed, allowing not only to regulate the heart rate, but also to prevent the development of severe conditions caused by pathology. Only after completing all diagnostic measures can the cause of the disease be accurately determined and treatment prescribed. Taking such pills on your own is dangerous; it can worsen your health and lead to dire consequences.