Establishing standardized, drug-specific washout periods for antiarrhythmics before electrophysiology procedures improves diagnostic accuracy and procedural success.
What are the optimal protocols and rationale for stopping antiarrhythmic drugs before interventional electrophysiology procedures?
This review provides a comprehensive, evidence-based guide for standardizing antiarrhythmic drug washout prior to EP procedures to ensure diagnostic accuracy and procedural success.
ABSTRACT This review examines the protocols and rationale for stopping antiarrhythmic drugs (AADs) before interventional electrophysiology (EP) procedures to establish a drug‐free baseline, ensuring diagnostic accuracy and procedural success. The review provided a detailed analysis of procedure‐specific AADs washout requirements for supraventricular tachycardia, atrial fibrillation, and ventricular tachycardia ablation, and a comprehensive, drug‐by‐drug guide to calculate washout periods, based on pharmacokinetic and pharmacodynamic principles. This guide details the half‐life, metabolism, and elimination pathways for all major AAD classes, and gives specific, actionable recommendations for adjusting wash‐out times based on patient‐specific factors, including age, renal function, and hepatic impairment. The aim is to provide clinicians with evidence‐based guidance for standardizing AADs washout, thereby improving the safety and success of interventional EP procedures.
Mugnai et al. (2026) studied this question. Establishing standardized, drug-specific washout periods for antiarrhythmics before electrophysiology procedures improves diagnostic accuracy and procedural success.
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