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Dysrhythmia
Antidysrhythmics
Four Phases
The SA node and the Purkinje cells each have
separate action potentials.
Action Potentials: Phases
(SA Node)
Action Potentials: Purkinje Fiber
Phase 2: plateu
Phase 0: fast Due to Ca++
upstroke influx
Due to Na+
influx
Phase 3:
repolarization
Due to K+ efflux
Phase 4: resting
membrane
potential
If the arrhythmia
arises from atria,
SA node, or AV
node it is called
supraventricular
arrhythmia
If the arrhythmia
arises from the
ventricles it is
called ventricular
arrhythmia
Factors precipitate
arrhythmias
• May includes :
• Ischemia, hypoxia, electrolytes
disturbance, excessive
catecholamines exposure , drug
toxicity.
Mechanisms of
arrhythmias
• Acceleration of pacemaker by
hypokalemia or β- adrenoceptor stimulants.
Class 1
Class Ia
Class Ib
Class Ic
Class II
Class III
Class IV
Other
Vaughan Williams Classification
Class I
Membrane-stabilizing agents
Fast sodium channel blockers
Divided into Ia, Ib, and Ic agents, according
to effects
Vaughan Williams Classification
Class I
moricizine
General Class I agent
Has characteristics of all three subclasses
Used for symptomatic ventricular and life-
threatening dysrhythmias
Vaughan Williams Classification
Class Ia
quinidine, procainamide, disopyramide
Block sodium channels
Delay repolarization
Increase the APD
Used for atrial fibrillation, premature atrial
contractions, premature ventricular contractions,
ventricular tachycardia, Wolff-Parkinson-White syndrome
Vaughan Williams Classification
Class Ib
tocainide, mexiletine, phenytoin, lidocaine
Block sodium channels
Accelerate repolarization
Decrease the APD
Used for ventricular dysrhythmias only
(premature ventricular contractions, ventricular
tachycardia, ventricular fibrillation)
Vaughan Williams Classification
Class Ic
encainide, flecainide, propafenone
Block sodium channels (more pronounced
effect)
Little effect on APD or repolarization
Used for severe ventricular dysrhythmias
Increase APD
Class IV
verapamil, diltiazem
Calcium channel blockers
Depress phase 4 depolarization
Used for paroxysmal supraventricular
tachycardia; rate control for atrial
fibrillation and flutter
Vaughan Williams Classification
Other Antidysrhythmics
digoxin, adenosine
Have properties of several classes and are
not placed into one particular class
Antidysrhythmics
Digoxin
Cardiac glycoside
adenosine (Adenocard)
Slows conduction through the AV node
Used to convert paroxysmal supraventricular tachycardia to
sinus rhythm
Very short half-life
Only administered as fast IV push
May cause asystole for a few seconds
Other side effects minimal
Antidysrhythmics: Side Effects
Class IA:
Oral quinidine + digoxin (or any drug from the 2nd step)
Use direct current in
Class IC: case of unstable
Oral propaphenone or IV/oral flecainide hemodynamic patient
Premature ventricular beat (PVB)
First choice: class II
•IV followed by oral
•Early after MI Avoid
using
Second choice: amiodarone class IC
after MI
↑
mortality