Herbal antiarrhythmic drugs for the heart. The most effective antiarrhythmic drugs

ANTI-ARRHYTHMIC MEDICINES

Used for heart rhythm disturbances - arrhythmias. The causes of arrhythmias are pathological changes in the myocardium.

Types of arrhythmias (determined by ECG data).

1.Depending on the location of the pathological focus:

a) supraventricular (supraventricular);

b) ventricular.

2.By the nature of the rhythm disturbance:

a) tachyarrhythmias (extrosystoles, paroxysmal tachycardias, flutters, atrial and ventricular fibrillation);

b) bradyarrhythmias (various blockades and weakness of the sinus node).

Mechanisms of arrhythmias

1. Violation of the formation of impulses, that is, the occurrence of pathological foci of excitation.

2. Impaired conduction of impulses as a result of a block.

MECHANISM OF EXCITATION AND CONTRACTION IN THE MYOCARDIUM

Under the influence of the action potential of the cells of the sinus node, the permeability of the cell membranes changes. Ca** and Na* enter the cell, K* comes out. The contractile mechanism is activated, contraction occurs, then Ca** ions are removed from the cell, and relaxation occurs.

Excitation (action potential)

Film membrane

Input Ca** and Na* Output K*

Cell contraction

Ca** yield

Relaxation of the cell

The main causes of rhythm disturbances are disturbances in electrolyte metabolism, that is, deficiency of K* and Mg**, excess Na* and Ca**, which arise in the myocardium under the influence of hypoxia, inflammatory processes, toxic or autoimmune damage, increased tone of SS innervation, excess thyroid hormones glands.

P\arrhythmic drugs belong to different chemical and pharmacological groups. Only quinidine, novocainamide, ethmosine and ajmaline are used only as antiarrhythmics.

CLASSIFICATION OF ANTI-ARRHYTHMIC DRUGS

I. For the treatment of tachyarrhythmias.

1) Membrane-stabilizing drugs (sodium channel blockers). Divided into 3 gr.

2) b-adrenolytics (b-blockers).

3) Drugs that slow down repolarization (potassium channel blockers).

4) Ca ion antagonists** (calcium channel blockers).

5) Drugs of other groups (cardiac glycosides, potassium drugs, magnesium drugs, hawthorn, adenosine).

II.For the treatment of bradyarrhythmias.

M-anticholinergics (iv 0.1% atropine solution).

B-adrenergic agonists (isadrin sublingually or intravenously, orciprenaline (alupent) orally).

The mechanism of action of all a/arrhythmic drugs is based on the effect on cell membranes and the transport of Na*, K*, Ca**, Cl* ions through them. As a result, electrophysiological processes in the myocardium change.

ANTI-ARRHYTHMIC DRUGS FOR TREATMENT OF TACHYARHYTHMIAS

Membrane-stabilizing drugs disrupt the transport of Na* and K* ions through the membranes of heart fibers. The properties of the fibers change, the excitability, conductivity and automaticity of the fibers of the cardiac conduction system decrease. Divided into 3 groups:

1gr.- Mech-m: block the entry of Na* ions through fast sodium channels of the cell membrane.

Application: extrasystoles, ventricular tachyarrhythmias, supraventricular (paroxysmal tachycardia, atrial fibrillation).

Side effects: appearance of signs of heart failure, decreased blood pressure, in large doses - AV block, m-x/blocking effect (dry mouth, blurred vision); when taken orally, nausea, vomiting.

Quinidine is an alkaloid from the bark of the cinchona tree. Dextrorotatory isomer of quinine.

Side effects: ototoxic, hemolysis, hepatitis. Not for arrhythmias associated with intoxication with cardiac glycosides.

FV tab 0.1 and 0.2.

Extended forms:

Quinidine-durules

Kinyleptin

Procainamide (Novocainamide) - similar in structure and properties to novocaine (has a local anesthetic effect), according to indications and physiological effects - with quinidine (less M-anticholinergic effect), in addition - convulsions, psychosis, a state similar to systemic redness lupus Not for arrhythmias associated with intoxication with cardiac glycosides.

FV tab 0.25; 10% solution, 5 ml.

Ajmaline (rauwolfia serpentine alkaloid) - parenteral.

Pulsnorma (ajmaline + phenobarbital) - antiarrhythmic and hypotensive, pills.

Disopyramide (rhythmilen, rhythmodan, norpace) has a negative inotropic effect and a peripheral anticholinergic effect.

2 gr.-Mech-m: promote the release of K* ions from myocardial cells, accelerate the process of repolarization of cell membranes, shorten the action potential and refractory period. Suppress the automaticity of ectopic foci of excitation in the ventricles. Do not have a negative effect on conductivity.

Lidocaine (xicaine) and Trimecaine are local anesthetics.

Application: drugs of choice for ventricular arrhythmias and myocardial infarction.

Side effects: dizziness, convulsions, nausea, vomiting, decreased blood pressure. Administer intramuscularly and intravenously.

Mexiletine (Ritalmex) and tocainide are an analogue of lidocaine, with a longer action, effective when taken orally.

FV capsules and solutions for intravenous administration.

Phenytoin (diphenin) is an antiepileptic drug. Similar to lidocaine in antiarrhythmic properties. Effective only for arrhythmias caused by intoxication with cardiac glycosides and heart surgery. FV tablets.

3 g. - Mech-m: (cm 1 g) - block the Na* input, but less than 1 g inhibit the conductivity and contractility of the myocardium.

Ethmozin (moritsizin) and etatsizin are well absorbed from the gastrointestinal tract. Prescribed orally and parenterally.

Application: ventricular arrhythmias.

Side effects: nausea, dizziness, blurred vision, intrinsic arrhythmogenic effect. FV tablet and 2.5% injection solution.

Beta-adrenolytics (see lecture “Beta-adrenolytics”)

Propranolol (anaprilin, obzidan) is a non-selective beta-blocker that blocks the effect of adrenergic innervation on the heart, as well as circulating adrenaline. At the same time, the activity of the sinus node and ectopic foci is suppressed. Reduces automaticity, excitability and conductivity of the myocardium. Stabilizes the content of potassium ion in the heart muscle. Effective for supraventricular and ventricular tachyarrhythmias, including those associated with cardiac glycosides.

Side effect: associated with blockade of beta2-adrenergic receptors in other organs (bronchospasm, cold extremities due to deterioration of peripheral circulation).

Atenolol (tenolol) is a beta1-adrenolytic (cardioselective). Does not cause side effects on beta2-adrenergic receptors, is better tolerated. It is used for the same indications as propranolol.

Analogues of atenolol: metoprolol, talinolol, bisoprolol, betaxolol, acebutolol, nebivolol, etc.

Drugs that slow down repolarization

Amiodarone (cordarone) is a highly effective antiarrhythmic drug. Mechanism of action: increases the duration of the action potential due to blockade of potassium channels. Slows down the conduction of impulses through the conduction system, but does not affect myocardial contractility. Dilates coronary vessels. Application: supraventricular and ventricular arrhythmias. Side effects: pigment deposition in the cornea of ​​the eye, headache, changes in the lungs, dysfunction of the thyroid gland (as it contains iodide ion).

Contraindications: atrioventricular conduction disorder, bradycardia, pregnancy, lactation. FV tab 0.2

Sotalol (Sotalex, Sotohexal) is a non-selective beta-blocker. Reduces blood pressure – even normal blood pressure. Lasts about 25 hours. But doctors recommend taking it 2 times a day.

Application: arrhythmias, angina pectoris. FV

Bretylium (ornid) is a sympatholytic, most effective for ventricular arrhythmias. VWF 5% solution for intravenous and intramuscular administration.

Calcium channel blockers (Ca2 ion antagonists**)

Mehm actions and f-log effects: block calcium channels in cell membranes, mainly in the smooth muscles of blood vessels and the heart. The antiarrhythmic effect is associated with a decrease in excitability, conductivity and automaticity of the fibers of the sinus and atrioventricular nodes. They have a negative inotropic effect (weaken, prolongs systole). As a result, they lower blood pressure, have an antiplatelet effect and reduce blood viscosity. They have an antianginal effect.

Verapamil (lecoptin, isoptin, veronorm) and diltiazem (cardil) are the drugs of choice for supraventricular tachyarrhythmias.

Side effect:

in high doses they reduce myocardial contractility, causing AV block;

constipation, headache, fatigue, swelling in the legs.

Drugs of other groups

Cardiac glycosides. For arrhythmias, only digitalis tablets are prescribed:

Purpurova: cordigititis, digitoxin;

Woolly: digoxin, medilazide, celanide

Potassium supplements cause an increase in heart rate. Reduce excitability, conductivity and contractility of the myocardium. In small doses they dilate the coronary vessels of the heart, in large doses they cause spasm of the coronary vessels.

Well absorbed from the gastrointestinal tract, excreted through the kidneys.

In case of an overdose, the phenomenon of paresthesia is observed: itching on the skin, burning, “crawling goosebumps” is accompanied by a tic on the face. Kidney function is impaired. Cardiac arrest as a result of spasm of the coronary vessels. Application: hypokalemia when taking soluretics, intoxication with digitalis drugs, arrhythmias.

Potassium chloride after meals, as it greatly irritates the gastrointestinal mucosa. FV tab 0.5

Potassium - normin, kalinor, kalipoz - tablet in a coating, before meals, without chewing.

Magnesium preparations reduce heart rate and the excitability of ventricular cardiomycetes.

Magnesium sulfate 20% solution is used to relieve ventricular arrhythmias and poisoning with cardiac glycosides.

Magnesium chloride, magnesium orotate (magnerot), magnesium aspartate and magnesium gluconate are used for the prevention and treatment of hypomagnesemia.

Magne B6, magnesium-plus, magnyl – combined magnesium preparations.

Combined preparations of potassium and magnesium. Application: heart rhythm disturbances caused by hypokalemia and hypomagnesemia.

Asparkam and panangin are analogues that contain potassium and magnesium aspartates. The action develops gradually. Asparkam acts more sharply and for less time. FV tabs, dragees, d/in solutions.

Polarizing mixture – composition: 5% glucose solution -500 ml; 6 units of insulin; 1.5 potassium chloride; 2.5 magnesium sulfate. IV drip.

Hawthorn tincture – hawthorn preparations increase contractions of the heart muscle and at the same time reduce its excitability. Increases blood circulation in the coronary vessels of the heart and in the vessels of the brain. Analogues: novocainamide, quinidine, etmozin.

Medicines for the treatment of bradyarrhythmias, bradycardias and conduction disorders (see classification).

Content

In medicine, antiarrhythmic drugs are used to normalize the rhythm of heart contractions. Such drugs are intended only to control the clinical symptoms of diseases in which the functioning of the heart muscle is impaired. Antiarrhythmics have no effect on life expectancy. Depending on the nature of changes in heart rhythm, antiarrhythmic drugs from different pharmacological groups and classes are prescribed. Their use should be long-term and under strict control of electrocardiography.

Indications for the use of antiarrhythmic drugs

The muscle cells of the heart, called cardiomyocytes, are riddled with a large number of ion channels. Arrhythmia is directly related to their work. It develops as follows:

1. Sodium, potassium and chloride ions move through cardiomyocytes.
2. Due to the movement of these particles, an action potential is formed - an electrical signal.
3. In a healthy state, cardiomyocytes contract synchronously, so the heart works normally.
4. With arrhythmia, this established mechanism malfunctions, which leads to disruption of the propagation of nerve impulses.

Antiarrhythmic drugs are used to restore normal heart contraction. Medicines help reduce the activity of the ectopic pacemaker. Literally, ectopia means the appearance of something in the wrong place. With an ectopic rhythm, electrical excitation of the heart occurs in any part of the conducting fibers of the myocardium, but not in the sinus node, which is an arrhythmia.

Drugs against arrhythmia act by blocking certain ion channels, which helps stop the circulation of the pathological impulse. The main indications for the use of such drugs are tachyarrhythmias and bradyarrhythmias. Certain medications are prescribed taking into account the clinical symptoms of the pathology and the presence or absence of structural pathologies of the heart. Arrhythmias for which antiarrhythmics are prescribed are associated with the following diseases:

• coronary heart disease (CHD);
• central nervous system (CNS) disorders;
• stress;
• hormonal disorders during pregnancy, menopause;
• inflammatory heart diseases (rheumatic carditis, myocarditis);
• imbalance of electrolytes with hypercalcemia and hypokalemia;
• hyperfunction of the thyroid gland and other endocrine pathologies;
• cardiopsychoneurosis.

Classification of antiarrhythmic drugs

The criterion for classifying antiarrhythmic drugs is their main effect on the production of electrical impulses in cardiomyocytes. Different antirhythmics show certain effectiveness only in relation to specific types of arrhythmia. Taking this factor into account, the following groups of antiarrhythmic drugs are distinguished:

• Class 1 antiarrhythmics are membrane-stabilizing sodium channel blockers. They directly affect the functional abilities of the myocardium.
• Class 2 antiarrhythmics - beta blockers. They act by reducing the excitability of the heart muscle.
• Class 3 antiarrhythmics are potassium channel blockers. These are new generation antiarrhythmic drugs. They slow down the flow of potassium ions, thereby lengthening the time of excitation of cardiomyocytes. This helps stabilize the electrical activity of the heart.
• Class 4 antiarrhythmics are calcium antagonists, or slow calcium channel blockers. They help to lengthen the time of insensitivity of the heart to a pathological impulse. As a result, the abnormal contraction is eliminated.
• Other antiarrhythmic drugs. These include tranquilizers, antidepressants, cardiac glycosides, sedatives, and neurotropic drugs. They have a complex effect on the myocardium and its innervation.
• Plant-based drugs with antiarrhythmogenic effects. These medications have a milder effect and fewer side effects.

Membrane-stabilizing sodium channel blockers

These are class 1 antiarrhythmic drugs. Their main effect is to stop the flow of sodium ions into cardiomyocytes. As a result, the excitation wave passing through the myocardium slows down. This eliminates the conditions for rapid circulation of ectopic signals in the heart. The result is that the arrhythmia stops. Sodium channel blockers are divided into 3 more subclasses depending on the effect on the repolarization time (returning the potential difference that occurs during depolarization to the original level):

• 1A – lengthen repolarization time;
• 1B – shorten the repolarization time;
• 1C – do not affect the repolarization time in any way.

1A class

These antiarrhythmic drugs are used for extrasystole - ventricular and supraventricular. Atrial fibrillation is also an indication for their use. This is a heart rhythm disorder in which the atria contract frequently and chaotically and fibrillation of individual groups of atrial muscle fibers is observed. The main effect of class 1A drugs is inhibition of rapid depolarization (extension of repolarization) of the action potential in the myocardium. Due to this, the normal sinus rhythm of heart contractions is restored. Examples of such drugs:

• Quinidine. Reduces the tone of veins and arteries, blocks the penetration of sodium ions into myocardial cells, exhibits antipyretic and analgesic effects. Indications: atrial fibrillation, paroxysmal supraventricular tachycardia, frequent extrasystole. Quinidine should be taken half an hour before meals. The standard dosage is 200–300 mg up to 4 times a day. contraindications: cardiac decompensation, pregnancy, idiosyncrasy. Side effects include nausea, vomiting, diarrhea, allergies, and cardiac depression.
• Novocainamide. Reduces the excitability of the heart, suppresses ectopic foci of excitation, and exhibits a local anesthetic effect. Indicated for extrasystole, paroxysmal atrial fibrillation, paroxysmal tachycardia. Initial dose – 1 tablet 1 hour before or 2 hours after meals. Then the dose is increased to 2-3 pieces per day. Maintenance dosage – 1 tablet every 6 hours. Novocainamide is prohibited in cases of cardiac conduction disturbances and severe heart failure. Its side effects include general weakness, insomnia, nausea, headache, and a sharp drop in blood pressure.

1B class

These antiarrhythmic drugs are ineffective for atrial fibrillation because they have little effect on the sinus node, the degree of conduction and contractility of the myocardium. In addition, such drugs shorten the repolarization time. For this reason, they are not used for supraventricular arrhythmia. Indications for their use:

• extrasystole;
• paroxysmal tachycardia;
• arrhythmias caused by an overdose of cardiac glycosides.

A representative of class 1B antiarrhythmics is the local anesthetic Lidocaine. Its active component increases the permeability of membranes to potassium ions and at the same time blocks sodium channels. Lidocaine affects cardiac contractility in significant dosages. Indications for use:

• ventricular arrhythmias;
• relief and prevention of repeated ventricular fibrillation in patients with acute coronary syndrome;
• repeated paroxysms of ventricular tachycardia, including in the post-infarction and early postoperative period.

To stop an arrhythmic attack, 200 mg of lidocaine is administered intramuscularly. If there is no therapeutic effect, the procedure is repeated after 3 hours. In severe cases of arrhythmia, intravenous injection followed by intramuscular injection is indicated. Lidocaine contraindications:

• sinoatrial block;
• severe bradycardia;
• cardiogenic shock;
• Adam-Stokes syndrome;
• pregnancy;
• lactation;
• sick sinus syndrome;
• heart failure;
• intraventricular conduction disorders.

Intravenous and intramuscular injections of Lidocaine are used with caution in chronic heart failure, sinus bradycardia, arterial hypotension, hepatic and renal dysfunction. Side effects of the drug:

• euphoria;
• dizziness;
• headache;
• disorientation;
• disturbances of consciousness;
• vomiting, nausea;
• collapse;
• bradycardia;
• decrease in pressure.

1C class

The arrhythmogenic effect of antiarrhythmic drugs in this group has led to restrictions on their use. Their main effect is to lengthen intracardiac conduction. A representative of such antiarrhythmics is the drug Ritmonorm based on propafenone. This active component slows down the blood flow of sodium ions into cardiomyocytes, thereby reducing their excitability. Indications for use of Ritmonorm:

• severe ventricular paroxysmal tachyarrhythmia, which poses a threat to life;
• supraventricular paroxysmal tachyarrhythmias;
• AV nodal and supraventricular tachycardia in persons with paroxysmal atrial fibrillation.

Ritmonorm tablets are taken orally, swallowed whole, so as not to feel their bitter taste. Adults weighing over 70 kg are prescribed 150 mg up to 3 times a day. After 3–4 days, the dosage can be increased to 300 mg 2 times. If the patient's weight is less than 70 kg, treatment begins with a lower dose. It is not increased if therapy lasts less than 3–4 days. Common side effects of Ritmonorm include nausea, vomiting, metallic taste in the mouth, dizziness, and headache. Contraindications to the use of this drug:

• myocardial infarction in the last 3 months;
• Brugada syndrome;
• changes in water and electrolyte balance;
• age under 18 years;
• myasthenia gravis;
• obstructive chronic pulmonary disease;
• combined use with Ritonavir;
• pronounced changes in the myocardium.

Beta blockers

Class 2 antiarrhythmics are called beta blockers. Their main actions are lowering blood pressure and dilating blood vessels. For this reason, they are often used for hypertension, myocardial infarction, and circulatory failure. In addition to lowering blood pressure, beta-blockers help normalize the pulse, even if the patient has resistance to cardiac glycosides.

Drugs in this group are effective in increasing the tone of the sympathetic nervous system against the background of stress, autonomic disorder, hypertension, and ischemia. Due to these pathologies, the level of catecholamines in the blood increases, including adrenaline, which acts on beta-adrenergic receptors of the myocardium. Beta blockers interfere with this process, preventing overstimulation of the heart. They have the described properties:

• Anaprilin. Based on propranolol, which is a non-selective adrenergic blocker. Reduces heart rate, reduces contractile force of the myocardium. Indications: sinus, atrial fibrillation and supraventricular tachycardia, arterial hypertension, angina pectoris, prevention of migraine attacks. Start taking 40 mg 2 times a day. The dose should not exceed 320 mg per day. For heart rhythm disturbances, it is recommended to take 20 mg 3 times a day with a gradual increase to 120 mg, divided into 2-3 doses. Contraindications: arterial hypotension, sinus bradycardia, sinotrial block, heart failure, bronchial asthma, metabolic acidosis, tendency to bronchospasm, vasomotor rhinitis. Adverse reactions may include the development of muscle weakness, Raynaud's syndrome, heart failure, vomiting, and abdominal pain.
• Metoprolol. This is a cardioselective adrenergic blocker with antianginal, hypotensive and antiarrhythmic effects. The drug is indicated for hypertension, myocardial infarction, supraventricular, ventricular, and atrial fibrillation, sinus and atrial tachycardia, atrial flutter and fibrillation, ventricular extrasystole. Daily dosage – 50 mg 1–2 times. The side effects of Metoprolol are numerous, so they should be clarified in the detailed instructions for the drug. The medicine is contraindicated for cardiogenic shock, acute heart failure, lactation, intravenous infusion of Verapamil, arterial hypotension.

Potassium channel blockers

These are class 3 antiarrhythmic drugs. They slow down electrical processes in cardiomyocytes by blocking the penetration of potassium ions into these cells. Amiodarone is most often used in this category of antiarrhythmics. It is based on the component of the same name, which exhibits coronary vasodilating, antiarrhythmic and antianginal effects. The latter is due to the blockade of b-adrenergic receptors. Additionally, Amiodarone reduces heart rate and blood pressure. Indications for use:

• paroxysm of flickering;
• prevention of ventricular fibrillation;
• ventricular tachycardia;
• atrial flutter;
• parasystole;
• ventricular and atrial extrasystoles;
• arrhythmias due to coronary and chronic heart failure;
• ventricular arrhythmias.

The initial dose of Amiodarone is 600–800 mg per day, divided into several doses. The total dosage should be 10 g, it is achieved in 5–8 days. After administration, dizziness, headaches, auditory hallucinations, pulmonary fibrosis, pleurisy, vision problems, sleep and memory disturbances may occur. Amiodron is contraindicated for:

• cardiogenic shock;
• collapse;
• hypokalemia;
• sinus bradycardia;
• insufficient secretion of thyroid hormones;
• thyrotoxicosis;
• taking MAO inhibitors;
• weak sinus node syndrome;
• under the age of 18.

Calcium antagonists

Class 4 antiarrhythmics are slow calcium channel blockers. Their action is to block the slow flow of calcium, which helps suppress ectopic foci in the atria and reduce the automaticity of the sinus node. These drugs are often used for hypertension because they can lower blood pressure. Examples of such drugs:

• Verapamil. It has antianginal, hypotensive and antiarrhythmic effects. Indications: atrial fibrillation, sinus, supraventricular tachycardia, supraventricular extrasystole, stable angina pectoris, hypertension. Verapamil is prohibited during pregnancy, lactation, severe bradycardia, and arterial hypotension. The dosage is 40–80 mg per day. After administration, facial flushing, bradycardia, nausea, constipation, dizziness, headache, and weight gain may occur.
• Diltiazem. It acts in the same way as Verapamil. Additionally improves coronary and cerebral blood flow. Diltiazem is used after myocardial infarction, for hypertension, diabetic retinopathy, angina pectoris, supraventricular tachycardia, and attacks of atrial fibrillation. The dosage is selected individually depending on the indications. Contraindications for Diltiazem: atrioventricular block, severe hypertension, atrial fibrillation and flutter, renal failure, lactation. Possible side effects: paresthesia, depression, dizziness, fatigue, bradycardia, constipation, nausea, dry mouth.

Other drugs for arrhythmia

There are drugs that are not antiarrhythmics, but have this effect. They help with paroxysmal tachycardia, mild attacks of atrial fibrillation, ventricular and supraventricular extrasystoles. Examples of such drugs:

• Cardiac glycosides: Korglykon, Strophanthin, Digoxin. They are used to restore sinus rhythm and relieve supraventricular tachycardia.
• Preparations containing magnesium and potassium ions: Panangin, Asparkam. They help reduce the speed of electrical processes in the myocardium. Indicated for ventricular and supraventricular rhythm disturbances.
• Anticholinergics: Atropine, Metacin. These are antiarrhythmic drugs for bradycardia.
• Magnesium sulfate. Used for pirouette-type arrhythmia that occurs after a liquid protein meal, long-term use of certain antiarrhythmics and severe electrolyte disturbances.

Antiarrhythmic drugs of plant origin

Herbal preparations, including antiarrhythmic ones, are safer. In addition to normalizing heart rate, most of them exhibit sedative, analgesic and antispasmodic effects. Examples of such drugs:

• Valerian. Contains extract of the plant of the same name. It has sedative, antiarrhythmic, choleretic and analgesic effects. You need to take 1 per day – 2 tablets or 20–40 drops 3 times. Contraindications: first trimester of pregnancy, deficiency of lactase, sucrase or isomaltase, age under 3 years, glucose-galactose absorption. Side effects include drowsiness, constipation, lethargy, and muscle weakness. Price – 50 tablets – 56 rub.
• Motherwort. Based on an extract of the plant of the same name. Shows hypotensive and sedative effects. The dosage is 14 mg 3-4 times a day. Contraindication – high sensitivity to the composition of the drug. Adverse reactions: rash, irritation and redness on the skin. The price of tablets is 17 rubles.
• Novo-passit. Contains extracts of hops, lemon balm, St. John's wort, hawthorn and guaifenesin. Has a sedative effect. The drug is taken 1 tablet 3 times a day. Adverse reactions: dizziness, vomiting, constipation, cramps, nausea, increased drowsiness. The drug is prohibited for myasthenia gravis, under the age of 12 years. Price – 660 rub. for 60 tablets.
• Persen. Contains extracts of lemon balm, peppermint, valerian. Shows calming, sedative and antispasmodic properties. Take the medicine 2-3 times a day, 2-3 tablets. After administration, constipation, skin rash, bronchospasm, and hyperemia may develop. Contraindications for Persen: arterial hypotension, fructose intolerance, pregnancy, lactation, age less than 12 years, cholelithiasis.

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Arrhythmia is a disorder or abnormal heart rate. The rhythm of myocardial function can be disrupted due to:

• changes in the regulation of heart activity;
• excitability disorders;
• automaticity and conductivity due to intoxication;
• ischemia;
• electrolyte disturbances.

To normalize heart rhythm, antiarrhythmic drugs are prescribed; they are very diverse in terms of pharmacological groups and classes. These chemical compounds are designed to eliminate the manifestations of arrhythmia and prevent their occurrence. With their help, it is impossible to increase life expectancy, however, it is possible to control the manifestations of clinical symptoms using them quite successfully.

Antiarrhythmics are serious drugs prescribed by a cardiologist when a patient is diagnosed with a pathological arrhythmia that interferes with a full life and threatens complications. These drugs have a positive effect on the human body, because a regulated heart rhythm ensures normal blood circulation and timely delivery of oxygen to cells, tissues, and internal organs, which ensures the proper functioning of all systems. The intake of these drugs is strictly controlled, their effects are monitored by electrocardiogram at least once every twenty days, the course of treatment is long.

Treatment of arrhythmia aims to restore sinus rhythm.

The patient is admitted to the cardiology department and takes antiarrhythmic drugs orally or administered intravenously. When the desired effect is not observed from the measures taken, electrical cardioversion is indicated. If there are no chronic heart pathologies, restoration of sinus rhythm can be done at home with periodic visits to the doctor. In rare attacks of arrhythmia, when symptoms are short and rare, medical monitoring becomes dynamic.

Mechanism of action

To stabilize the heart rate, patients are shown antiarrhythmic drugs that affect the electrophysiology of the myocardium and promote:

1. Reducing the level of excitability of the heart muscle.
2. Slowing down the sharpness of the potential, leading to a decrease in excitation.
3. Reducing the sensitivity of the heart to electrical discharge and the risk of ventricular fibrillation.
4. Increasing the period of effective refractoriness, reducing tachycardic manifestations, as well as eliminating impulses that follow immediately after the optimal contraction with virtually no interruption.
5. Reducing the duration of relative refractoriness and shortening the interval when a contractile impulse is possible.
6. A rapid reduction in the probability of the “re-entry” phenomenon, as homogenization occurs due to the rapidly increasing speed of conducted excitation.
7. An increase in the duration of diastolic depolarization, which suppresses the focus of ectopic automatism.
8. An equal period of time during which refractoriness and excitation occur.

Classification

The classification of antiarrhythmic drugs is considered into four main classes, separated depending on the ability of a particular drug to conduct electrical signals. There are several types of arrhythmia, according to which a specific type of drug is selected that differs in its effect. Below are popular antiarrhythmic drugs, the classification of which is expressed according to the main methods and areas of influence:

1. Membrane-stabilizing sodium channel blockers that affect the performance of the heart muscle: Quinidine, Flecainide, Lidocaine.
2. Beta blockers are able to coordinate the innervation of the myocardium, reduce the risk of death due to coronary insufficiency, and prevent the recurrence of tachyarrhythmia. This group includes: “Bisoprolol”, “Propranolol”, “Metoprolol”.
3. Potassium channel blockers: Ibutilide, Sotalol, Amiodarone.
4. Calcium antagonists: Diltiazem, Verapamil.

There are also other medications, which include tranquilizers, cardiac glycosides, neurotropic and sedatives. They have a combined effect on the innervation and functioning of the myocardium.

Features of the main antiarrhythmics

Class	Name of medicine	Impact	Mode of application
1A	Quinidine (Cinchona bark)	prevents sodium ions from penetrating cardiomyocytes; reduces arterial and venous tone; acts as an antipyretic, analgesic, irritant; has a depressing effect on brain function; affects smooth muscles, blood vessels and the central nervous system.	Orally during meals, without chewing
1B	"Lidocaine"	blocks sodium channels; increases the penetrating ability of membranes; copes with attacks of ventricular tachycardia after a heart attack and immediately after surgery.	200 mg of the drug is administered intramuscularly. If there is no positive dynamics, after 3 hours the injection is duplicated. Particularly severe cases require intravenous administration
1C	"Propafenon", "Ritomnorm"	treats extrasystole - arrhythmia caused by premature contraction of the myocardium; acts as a local anesthetic; stabilizes myocardial membranes; raises the excitability threshold of cardiomitocytes; reduces the rate of penetration of sodium ions into them.
2	"Propranolol" - beta blocker	dilates blood vessels; stimulates bronchial tone; lowers blood pressure; normalizes heart rhythm even if the body is resistant to cardiac glycosides; transforms atrial fibrillation into bradyarrhythmia; eliminates interruptions in myocardial function.	Due to gradual accumulation in tissues, dosages are reduced in elderly patients over time.
3		acts as a blocker of adrenergic receptors and potassium channels; slows down electrical processes in cardiomyocytes; dilates coronary vessels; reduces blood pressure; normalizes pulse; reduces the tone of the coronary arteries; prevents hypoxia of the heart muscle.	Since the drug is toxic, the dose is prescribed individually, and it is necessary to constantly monitor blood pressure and other criteria
4	"Verapamil"	has a beneficial effect on general well-being in severe forms of hypertension, arrhythmia, angina pectoris; dilates coronary vessels, stimulating blood flow; reduces the heart’s tendency to hypoxia; brings rheological blood parameters back to normal.	After accumulation, it is excreted by the kidneys. Release form: tablets, injections, dragees. The number of contraindications is minimal, well tolerated in most cases

Other medications that stabilize heart rhythm

The above classification of antiarrhythmic drugs does not include some drugs that also have a similar effect on the heart muscle. Among them:

1. Cardiac glycosides: inhibit heart rate. Prominent representatives of the group are “Strophanthin”, “Digoxin”.
2. Anticholinergics: accelerate the heart rate during bradycardia. This includes Atropine.
3. Magnesium sulfate eliminates a phenomenon called "pirouette". This is a special ventricular tachycardia that occurs as a result of electrolyte disturbances. It is also provoked by a liquid protein diet and prolonged exposure to certain antiarrhythmics.

Herbal anti-arrhythmia drugs

Among the remedies of natural origin there are medicines used in modern traditional medicine to normalize heart rhythm.

1. Motherwort. Base for alcohol tincture. The optimal dosage of the medicine is 30 drops, taken three times a day. To prepare a motherwort infusion at home, you need to take a spoonful of the herb, pour boiling water over it, leave for about an hour and drink 50 ml three times a day.
2. Valerian. In pharmacies it is found in crushed, dried form, in tablets and in tincture form. Valerian relieves pain, normalizes heart rate, and has sedative properties. With long-term therapy, it is used as an antidepressant and a remedy for insomnia.
3. "Persen." Antispasmodic, antiarrhythmic, sedative, normalizes sleep, stimulates appetite. Due to the presence of mint, lemon balm, and valerian in the composition, clear antiarrhythmic and sedative effects can be observed. With the help of “Persen” you can relieve tension, reduce emotional irritability, and also get rid of mental fatigue.
4. “Novopassit” is a mixture of medicinal herbs such as hops, hawthorn, St. John’s wort, lemon balm, elderberry, passionflower. The drug is widely used as an antiarrhythmic drug. As for the dosage, one teaspoon three times a day is enough.

Side effects of antiarrhythmic drugs

Unfortunately, this does not happen without negative consequences. Drugs with this spectrum of action have a number of side effects:

1. In almost half of the cases, antiarrhythmics are able to act on the contrary, that is, provoke the development of arrhythmia. These so-called arrhythmogenic effects can be life-threatening.
2. From the central nervous system, headaches, dizziness, convulsions, fainting, tremors, drowsiness, arterial hypotension, double vision, and respiratory arrest may occur.
3. With long-term therapy, bronchospasms, liver failure, and dyspepsia are possible.
4. Due to the anticholinergic effect, after taking 1 group of antiarrhythmic drugs, elderly people or people with poor health experience difficulty urinating, spasm of accommodation, and dry mouth.
5. Some of these medications (Novocainamide, Lidocaine, Amiodarone) can cause allergic reactions, thrombocytopenia, agranulocytosis, drug fever, and leukopenia.

Heart and vascular diseases are often causes of death, especially in old age. Impaired myocardial functioning leads to an impressive list of dangerous diseases, one of which is arrhythmia. This disease cannot be left to chance; self-treatment is not allowed. The intervention of a professional is mandatory, who will prescribe a thorough examination of the patient and a full course of antiarrhythmic therapy.

Almost all of the cardiologist’s patients have encountered various types of arrhythmias in one way or another. Currently, the pharmacological industry offers a wide variety of antiarrhythmic drugs. We will consider their classification and characteristics in this article.

Routes 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 medications 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 of influence of drugs on the ability of heart cells to produce 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 fast sodium channel blockers. Subclass IA includes medications such as Quinidine, Disopyramide, Novocainamide, Gilurythmal. Subclass IB includes “Piromecaine”, “Tocainide”, “Difenin”, “Lidocaine”, “Aprindin”, “Trimecaine”, “Mexiletine”. Subclass IC is formed by such drugs as “Etmozin”, “Ritmonorm” (“Propafenone”), “Allapinin”, “Etatsizin”, “Flecainide”, “Indecainide”, “Bonnecor”, “Lorcainide”.

The second class consists of beta-blockers (Metoprolol, Nadolol, Alprenolol, Cordanum, Propranolol, Acebutalol, Pindolol, Trazikor, Esmolol).

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

The fourth class includes slow calcium channel blockers (for example, Verapamil).

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

First class drugs

Fast sodium channel blockers stop the entry of sodium into cells, which slows down the passage of excitation waves 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 take a closer look at the groups of antiarrhythmic drugs belonging to the first class.

Class IA drugs

Such antiarrhythmic drugs are prescribed for supraventricular and supraventricular), as well as for the purpose of restoring 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 tell you more about them.

"Quinidine"

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

Poisoning with antiarrhythmic drugs is rare, but when taking Quinidine, side effects such as indigestion (vomiting, loose stools) and headaches are possible. 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 electrocardiogram monitoring and under the supervision of a specialist.

The medicine is contraindicated in cases of intraventricular and atrioventricular block, intoxication with cardiac glycosides, thrombocytopenia, arterial hypotension, heart failure, and pregnancy.

"Novocainamide"

This medication has the same indications for use as Quinidine. Quite often it is prescribed to relieve paroxysms of atrial fibrillation. With 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.

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

The use of the medication is prohibited in case of atrioventricular block, 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 arrhythmia. These antiarrhythmic drugs are prescribed for extrasystole, paroxysmal tachycardia, that is, for the treatment of ventricular arrhythmias. They are also used to treat arrhythmias that are caused by an overdose of cardiac glycosides.

The list of antiarrhythmic drugs in this class is quite extensive, but the most commonly used drug 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 confusion. If the drug is administered in a large dose, the heart rate may slow down and the contractility of the heart may decrease. In addition, allergic reactions in the form of Quincke's edema, urticaria, and skin itching are possible.

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

Class IC

Drugs belonging to this class prolong 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 SVC syndrome. Since there is a risk of 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. Negative effects such as visual disturbances, changes in blood tests, dizziness, insomnia, and depression cannot be ruled out.

Beta blockers

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

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

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

The antiarrhythmic drugs under consideration are ineffective for atrial fibrillation, except in cases where the pathology is caused precisely by an excess of catecholamine in the blood.

Metoprolol and Anaprilin are often used to treat rhythm disturbances. These medications have side effects such as slowing the pulse, reducing myocardial contractility, and causing atrioventricular block. These medications can cause coldness of the extremities and deterioration of peripheral blood flow. In addition, the drugs affect the nervous system, causing drowsiness, dizziness, depression, and memory impairment. They also change conduction in nerves and muscles, resulting in fatigue and weakness.

Beta-blockers are prohibited for use in cardiogenic shock, pulmonary edema, insulin-dependent diabetes mellitus, and bronchial asthma. Second-degree atrioventricular block and sinus bradycardia are also contraindications.

Potassium channel blockers

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

"Cordarone" is used for the treatment and prevention of ventricular, atrial fibrillation and supraventricular arrhythmia, cardiac arrhythmias associated with SVC syndrome. The medication is also prescribed to prevent life-threatening ventricular arrhythmia in patients with acute infarction. In addition, it is used to reduce 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 tint) may develop. In some cases, headaches, sleep disturbances, memory, and vision appear. Taking Amiodarone may cause the development of sinus bradycardia, constipation, nausea and vomiting.

The medication is not prescribed for initial bradycardia, prolongation of the Q-T interval, intracardiac conduction disorders, thyroid diseases, arterial hypotension, pregnancy, bronchial asthma.

Slow calcium channel blockers

These drugs block the slow flow of calcium, thereby suppressing ectopic foci in the atria and reducing the automaticity 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, decreased cardiac contractility.

Cardiac glycosides

The classification of antiarrhythmic drugs would 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 include abdominal pain, nausea and vomiting, headaches, visual and sleep disturbances, and nosebleeds.

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

Combination of antiarrhythmic drugs

For ectopic rhythms, certain combinations of medications are used in clinical practice. Thus, Quinidine can be used in conjunction with cardiac glycosides to treat persistent extrasystole. With beta-blockers, Quinidine can be prescribed to relieve ventricular arrhythmia that is not amenable to other treatment. The combined use of beta-blockers and cardiac glycosides gives a good effect against ventricular and supraventricular extrasystoles, and also helps prevent relapses of tachyarrhythmias and ectopic tachycardias.

Whether there is an arrhythmia, where and why it occurred, whether it should be treated can only be determined by a cardiologist. Only a specialist can understand the variety of antiarrhythmic drugs. The use of many drugs is indicated for narrow pathologies and has a lot of contraindications. Therefore, drugs from this list should not be prescribed to oneself.

There are many disorders that cause all known types of arrhythmia. They are not always directly related to heart pathology. But affecting the work of this important organ, they can cause acute and chronic heart rhythm pathologies that are life-threatening.

General picture of arrhythmia

The heart performs its work under the influence of electrical impulses. The signal is born in the main center that controls contractions - the sinus node. Next, the impulse is transported to both atria along conduction tracts and bundles. The signal, entering the next atrioventricular node, spreads through the His bundle to the right and left atrium along nerve endings and groups of fibers.

The coordinated work of all parts of this complex mechanism ensures a rhythmic heartbeat at a normal frequency (from 60 to 100 beats per minute). A violation in any area causes a failure and disrupts the frequency of contractions. Moreover, disturbances can be of different orders: irregular functioning of the sinuses, the inability of muscles to carry out orders, disruption of the conduction of nerve bundles.

Any obstacle in the way of the signal or its weakness also leads to the fact that the transmission of the command will follow a completely different scenario, which provokes chaotic, irregular contractions of the heart.

The reasons for some of these violations have not yet been fully established. Like the mechanism of action of many drugs that help restore the usual rhythm, it is not completely clear. However, many effective drugs have been developed for the treatment and immediate relief of arrhythmia. With their help, most violations are successfully eliminated or can be corrected over a long period of time.

Classification of antiarrhythmic drugs

An electrical impulse is transmitted due to the constant movement of positively charged particles - ions. The heart rate (HR) is affected by the penetration of sodium, potassium, and calcium ions into the cells. By preventing them from passing through special channels in cell membranes, the signal itself can be affected.

Medicines for arrhythmia are grouped not according to the active substance, but according to the effect they produce on the conduction system of the heart. Substances with completely different chemical compositions can have a similar effect on heart contractions. According to this principle, antiarrhythmic drugs (AAP) were classified by Vaughan Williams in the 60s of the 20th century.

The simplest classification according to Williams distinguishes 4 main classes of AAP and is generally applicable to this day.

Traditional classification of antiarrhythmic drugs:

• Class I – block sodium ions;
• Class II – beta-blockers;
• Class III – blocks potassium particles;
• Class IV – calcium antagonists;
• Class V is conditional and includes all antiarrhythmic drugs that are not included in the classification.

Even with subsequent modifications, such a division is not considered ideal. But attempts to propose a distinction between antiarrhythmic drugs based on other principles have not yet been successful. Let's look at each class and subclass of AAP in more detail.

Blockers Na- channels (1 class)

The mechanism of action of class 1 drugs is based on the ability of some substances to block sodium channels and slow down the speed of propagation of electrical impulses throughout the myocardium. The electrical signal in arrhythmic disorders often moves in a circle, causing additional contractions of the heart muscle that are not controlled by the main sinus. Blocking sodium ions helps correct precisely such violations.

Class 1 is the largest group of antiarrhythmic drugs, which is divided into 3 subclasses: 1A, 1B and 1C. They all have a similar effect on the heart, reducing the number of its contractions per minute, but each has some features.

1A – description, list

In addition to sodium, drugs block potassium channels. In addition to good antiarrhythmic properties, they additionally have a local anesthetic effect, since blocking the channels of the same name in the nervous system leads to a strong anesthetic effect. List of commonly prescribed drugs of group 1A:

• Novocainamide;
• Quinidine;
• Aymalin;
• Gilurithmal;
• Disopyramide.

The drugs are effective in relieving many acute conditions: extrasystole (ventricular and supraventricular), atrial fibrillation and its paroxysms, some tachycardias, including WPW (premature ventricular excitation).

Novocainamide and quinidine are used more often than other drugs in the group. Both drugs are available in tablet form. They are used for the same indications: supraventricular tachycardia, atrial fibrillation with a tendency to paroxysms. But the drugs have various contraindications and possible negative consequences.

Due to severe toxicity and many non-cardiological side effects, class 1A is primarily used to relieve an attack; for long-term therapy it is prescribed when it is impossible to use medications from other groups.

Attention! Arrhythmogenic effects of AAP! When treated with antiarrhythmic drugs, in 10% of cases (for 1C - in 20%), the opposite effect to the intended one occurs. Instead of stopping the attack or reducing the heart rate, the initial condition may worsen and fibrillation may occur. Arrhythmogenic effects pose a real threat to life. Taking any type of AAP must be prescribed by a cardiologist and must be carried out under his supervision.

1B – properties, list

They differ in the property that they do not inhibit, like 1A, but activate potassium channels. They are used mainly for ventricular pathologies: tachycardia, extrasystole, paroxysm. Most often, they require a jet or drip intravenous administration. Recently, many class 1B antiarrhythmic drugs are available in tablet form (for example, Diphenin). The subgroup includes:

• Lidocaine;
• Difenin;
• Mexiletine;
• Pyromecaine;
• Trimecaine;
• Phenytoin;
• Aprindin.

The properties of medications in this group make it possible to use them even during myocardial infarction. The main side effects are associated with significant depression of the nervous system; there are practically no cardiac complications.

Lidocaine is the most famous drug on the list, famous for its excellent anesthetic properties, which are used in all branches of medicine. It is characteristic that the effectiveness of the drug taken orally is practically not observed; it is with intravenous infusion that lidocaine has the strongest antiarrhythmic effect. The most effective jet injection is rapid. Often causes allergic reactions.

1C – list and contraindications

The most powerful blockers of sodium and calcium ions act at all levels of signal transmission, starting with the sinus node. They are used mainly internally. Medicines from this group have a wide range of applications and are highly effective in atrial fibrillation and tachycardias of various origins. Frequently used means:

• Propafenone;
• Flecainide;
• Indecainide;
• Ethacizin;
• Ethmozin;
• Lorcainide.

They are used for both rapid relief and permanent treatment of supraventricular and ventricular arrhythmias. Medicines from this group are not applicable for any organic heart damage.

Propaferon (rhythmonorm) has only recently become available in intravenous form. It has a membrane-stabilizing effect, exhibits beta-blocker properties, and is used for paroxysmal rhythm disturbances (extrasystole, atrial fibrillation and flutter), WPW syndrome, atrioventricular tachycardia, and as a prophylaxis.

The entire 1st class has limitations in use in cases of organic damage to the myocardium, serious heart failure, scars, and other pathological changes in heart tissue. After conducting statistical studies, an increase in the mortality rate of patients with similar diseases was found when treated with this class of AAP.

The latest generation antiarrhythmic drugs, often called beta blockers, compare favorably in these indicators with class 1 antiarrhythmics and are increasingly used in practice. The introduction of these drugs into the course of treatment significantly reduces the likelihood of an arrhythmogenic effect of medications from other groups.

Beta blockers – class II

Block adrenergic receptors, slow heart rate. Monitor contractions during atrial fibrillation, fibrillation, and some tachycardias. They help avoid the influence of stressful conditions by blocking the ability of catecholamines (in particular adrenaline) to act on andrenergic receptors and cause increased heart rate.

After a heart attack, the use of beta blockers significantly reduces the risk of sudden death. Well proven in the treatment of arrhythmias:

• Propranolol;
• Metoprolol;
• Cordanum;
• Acebutalol;
• Trazikor;
• Nadolol.

Long-term use can cause sexual dysfunction, bronchopulmonary disorders, and increased blood sugar. β-blockers are absolutely contraindicated in certain conditions: acute and chronic forms of heart failure, bradycardia, hypotension.

Important! Beta blockers cause withdrawal syndrome, so it is not recommended to stop taking them abruptly - only according to the regimen, for two weeks. It is not advisable to skip taking pills or take breaks from treatment without permission.

Significant depression of the central nervous system is observed with long-term use: memory deteriorates, depressive states occur, and general weakness and lethargy of the musculoskeletal system is noted.

Blockers TO- channels – III class

They block charged potassium atoms at the entrance to the cell. Heart rhythms, unlike class 1 drugs, slow down slightly, but are able to stop long-term, months-long atrial fibrillation, where other drugs are powerless. Comparable in action to electrocardioversion (restoration of heart rhythm using an electrical discharge).

Arrhythmic side effects are less than 1%, however, a large number of non-cardiac side effects require constant medical monitoring during treatment.

List of commonly used products:

• Amiodarone;
• Bretylium;
• Sotalol;
• Ibutilide;
• Refralol;

The most commonly used drug on the list is amiodarone (cordarone), which exhibits the properties of all classes of antiarrhythmic drugs and is additionally an antioxidant.

Note!Cordarone can be called the most effective antiarrhythmic drug today. Like beta blockers, it is the first choice drug for arrhythmic disorders of any complexity.

The latest generation class III antiarrhythmic drugs include dofetilide, ibutilide, and nibentan. They are used for atrial fibrillation, but the risk of tachycardia of the “pirouette” type increases significantly.

The peculiarity of only class 3 is the ability to cause severe forms of tachycardia when taken together with cardiological and other arrhythmic drugs, antibiotics (macrolides), antihistamines, and diuretics. Cardiac complications in such combinations can cause sudden death syndrome.

Calcium blockers class IV

By reducing the flow of charged calcium particles into cells, they act on both the heart and blood vessels, and affect the automaticity of the sinus node. By reducing myocardial contractions, they simultaneously dilate blood vessels, lower blood pressure, and prevent the formation of blood clots.

• Verapamil;
• Dilthiozel;
• Nifedipine;
• Diltiazem.

Class 4 drugs allow you to correct arrhythmic disorders in hypertension, angina, and myocardial infarction. Should be used with caution in atrial fibrillation with SVC syndrome. Cardiac side effects include hypotension, bradycardia, circulatory failure (especially in combination with β-blockers).

Antiarrhythmic drugs of the latest generation, the mechanism of action of which is blocking calcium channels, have a prolonged effect, which allows them to be taken 1-2 times a day.

Other antiarrhythmic drugs – class V

Medicines that have a positive effect on arrhythmias, but do not fall into the Williams classification according to their mechanism of action, are combined into the conditional 5th group of drugs.

Cardiac glycosides

The mechanism of action of the drugs is based on the properties of natural heart poisons to have a positive effect on the cardiovascular system, subject to the correct dosage. By reducing the number of heart contractions, they simultaneously increase their efficiency.

Plant poisons are used for immediate relief of tachycardia and are applicable in long-term treatment of rhythm disturbances due to chronic heart failure. They slow down the conduction of nodes and are often used to correct atrial flutter and fibrillation. Can replace beta-blockers if their use is contraindicated.

List of plant glycosides:

1. Digoxin.
2. Strophanin;
3. Ivabradine;
4. Korglykon;
5. Atropine.

An overdose can cause tachycardia, atrial fibrillation and lead to ventricular fibrillation. With prolonged use, they accumulate in the body, causing specific intoxication.

Sodium, potassium, magnesium salts

Replenishes the deficiency of vital minerals. They change the balance of electrolytes, allow you to relieve oversaturation with other ions (in particular calcium), lower blood pressure, and calm uncomplicated tachycardia. They show good results in the treatment of glycoside intoxications and the prevention of arrhythmogenic effects characteristic of classes 1 and 3 of AAP. The following forms are used:

1. Magnesium sulfate.
2. Sodium chloride.
3. Potassium chloride.

Prescribed in various forms for the prevention of many cardiac disorders. The most popular pharmaceutical forms of salts: Magnesium-B6, Magnerot, Orocomag, Panangin, Asparkam, Potassium and magnesium aspartate. On the recommendation of a doctor, a course of drugs from the list or vitamins with mineral supplements may be prescribed for recovery after exacerbations.

Adenazine (ATP)

Urgent administration of adenosine triphosphate intravenously stops most attacks of sudden paroxysm. Due to the short period of action, in emergency cases it can be used several times in a row.

As a universal source of “fast” energy, it provides supportive therapy for a whole range of cardiac pathologies and is widely used for their prevention. Not prescribed together with cardiac glycosides and mineral supplements.

Ephedrine, isadrine

In contrast to beta blockers, the substances increase the sensitivity of receptors and stimulate the nervous and cardiovascular systems. This property is used to correct the contraction frequency during bradycardia. Long-term use is not recommended; they are used as emergency medications.

Prescribing classical antiarrhythmic drugs is complicated by the limited ability to predict their effectiveness and safety for each individual patient. This often leads to the need to search for the best option using the selection method. The accumulation of negative factors requires constant monitoring and examinations during the treatment process.

Latest generation antiarrhythmic drugs

In the development of drugs for arrhythmia of a new generation, promising directions are the search for drugs with bradycardic properties and the development of atrial-selective drugs. Several new antiarrhythmics that can help treat ischemic disorders and the arrhythmias caused by them are in clinical trials.

Modification of known effective antiarrhythmic drugs (for example, Amiodarone and Carvedilol) is being carried out in order to reduce their toxicity and mutual influence with other cardiac drugs. The properties of drugs that were not previously considered as antiarrhythmics are being studied; this group also includes fish oil and ACE inhibitors.

The goal of developing new drugs for arrhythmia is to produce affordable drugs with the least side effects, and to ensure a longer duration of action compared to existing ones, allowing for a single daily dose.

The above classification is simplified; the list of drugs is very large and is updated all the time. The purpose of each of them has its own reasons, characteristics and consequences for the body. Only a cardiologist can know them and prevent or correct possible deviations. Arrhythmia, complicated by serious pathologies, cannot be treated at home; prescribing treatment and medications on your own is a very dangerous task.