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May inform antiarrhythmic selection in select cases; leaves open need for updated, trial-validated classifications.
Several classifications of antiarrhythmic drugs have appeared and all suffer considerable limitations. Recently a Task Force of the Working Group on Arrhythmias of the European Society of Cardiology proposed a novel classification of antiarrhythmic drugs (the so-called Sicilian Gambit) based on their action on the most vulnerable parameter of an arrhythmogenic mechanism. The present article attempts a critical reappraisal of the antiarrhythmic drug actions and the relationship of vulnerable parameters with cellular mechanisms such as ion channels. The clinical applicability of these concepts, the implications of the new classification in the pharmacologic therapy of arrhythmias, and its potential limitations are discussed.
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Katritsis et al. (1994) studied this question.
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