Talk:Antiarrhythmic agent

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Important trials involving mortality in antiarrhythmic agents (Will be added to references, eventually)

The Cardiac Arrhythmia Suppression Trial (CAST)

  • The CAST investigators: Preliminary report: effect of encainide and flecainide on mortality in a randomised trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989, 321:406–412.
  • Why such an old reference? Why not (e.g.) Nichol G, McAlister F, Pham B, Laupacis A, Shea B, Green M, Tang A, Wells G. Meta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation. Heart 2002 Jun;87(6):535-43. (Conclusion is "It is unclear whether any antiarrhythmic drug class is associated with increased or decreased mortality")? --Hugh2414 13:14, 26 Apr 2004 (UTC)
Because I didn't check for a newer reference. :-). I added that reference, but I left the AFFIRM trial, since it's pretty well knonwn in the cardiology media, from what I can gather. Ksheka 18:20, Apr 26, 2004 (UTC)

ppl i am studying in RCSI and my sources say that THERE IS SOMETHING WRONG WITH THE EXPLANATION ON THE CLASS 1a and CLASS 1c drugs. Isn't it supposed to be THE OTHER WAY ROUND? PLEASE MAKE SURE OF THIS and mark me if i'm wrong thanks


In my opinion, the paragraph:

"In the past, it was believed that suppression of the potentially dangerous ventricular arrhythmias, ventricular tachycardia and ventricular fibrillation would prolong life, but it was found in large clinical trials that suppression of these arrhythmias would paradoxically increase mortality3,4, which may happen due to the increased workload these drugs place on the heart."

can be absolutely misleading, raising doubts on the use of antiarrhythmic agents which are indeed widely prescribed in the clinical practice. The only problem with CAST (and other trials, such as SWORD) was that the used drugs were antiarrhythmic in one sense, but proarrhythmic in another. Now that our present knowledge in the use of antiarrhythmic drugs is wider than at the end of the 80's, we won't make again the same errors than in the past.

Between, explanation on classes 1A and 1C is fine.

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