Proarrhythmia

A Paradoxic Response to Antiarrhythmic Agents

Patrick L. McCollam, Robert Parker, Karen J. Beckman, Robert J. Hariman, Jerry L. Bauman

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Antiarrhythmic drugs may effectively terminate and prevent symptomatic tachycardias, but they may also provoke life‐threatening rhythm disturbances. The electrophysiologic mechanisms responsible for proarrhythmia can be extrapolated from the existing models of reentry and abnormal automaticity. Although all antiarrhythmic drugs may cause proarrhythmia with seemingly similar frequency, the profile of the disturbance with each class of agents appears somewhat distinct. All agents may cause an increased frequency of premature beats or new or worsened ventricular tachycardia, but the classic form of proarrhythmia due to type Ia agents is torsades de pointes. Recent information has provided clues to the underlying mechanism of drug‐induced torsades de pointes and has provided a clinical picture of patients with this adverse effect. Types Ib and Ic agents only rarely precipitate torsades de pointes. The latter, however, may cause a rapid, sustained, monomorphic ventricular tachycardia in certain high‐risk patients that can be resistant to resuscitation efforts. Amiodarone may cause a broad variety of arrhythmias that are complicated by their extended duration and difficulty in distinguishing proarrhythmia from simple inefficacy. Proarrhythmia is a relatively common, paradoxic side effect that necessitates the clinician to make careful risk‐benefit decisions in choosing antiarrhythmic drug therapy. 1989 Pharmacotherapy Publications Inc.

Original languageEnglish (US)
Pages (from-to)144-153
Number of pages10
JournalPharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Volume9
Issue number3
DOIs
StatePublished - Jan 1 1989
Externally publishedYes

Fingerprint

Torsades de Pointes
Anti-Arrhythmia Agents
Ventricular Tachycardia
Premature Cardiac Complexes
Drug Therapy
Amiodarone
Tachycardia
Resuscitation
Publications
Cardiac Arrhythmias

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

Proarrhythmia : A Paradoxic Response to Antiarrhythmic Agents. / McCollam, Patrick L.; Parker, Robert; Beckman, Karen J.; Hariman, Robert J.; Bauman, Jerry L.

In: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, Vol. 9, No. 3, 01.01.1989, p. 144-153.

Research output: Contribution to journalReview article

McCollam, Patrick L. ; Parker, Robert ; Beckman, Karen J. ; Hariman, Robert J. ; Bauman, Jerry L. / Proarrhythmia : A Paradoxic Response to Antiarrhythmic Agents. In: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 1989 ; Vol. 9, No. 3. pp. 144-153.
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