Section Review: Cardiovascular & Renal: Developments in antiarrhythmic drugs: An overview

In the more industrialised part of the world, sudden cardiac (arrhythmic) death has remained, throughout recent years, the leading cause of mortality. Preventing lethal arrhythmias has been a top priority in medical research and the literature abounds with reports describing the mechanisms of action of anti- or pro-arrhythmic agents and their cardiac electrophysiological effects. Studies such as the Cardiac Arrhythmia Suppression Trials (CAST-I and -II) [1], CASCADE (Cardiac Arrest in Seattle, Conventional versus Amiodarone Drug Evaluation) [2], CASH (Cardiac Arrest Study Hamburg), CAMIAT (Canadian Amiodarone Myocardial Infarction Arrhythmia Trial) [3], ESVEM (Electrophysiologic Study versus Electrocardiographic Monitoring Trial) [4], CAPS (Cardiac Arrhythmia Pilot Study) and DAVIT (Danish Verapamil Infarction Trial) [5] for example, and new approaches to the classification of antiarrhythmic drugs, based on their actions on arrhythmogenic mechanisms and studies of ‘cardioprotective’ agents and potassium channel openers are also under way.Despite technical advances in treatment, diseases of the heart are still the most significant killers. In the US alone, approximately seventy million people suffer from one or more forms of heart disease. In response to the ongoing challenge of cardiovascular disease, pharmaceutical and biotechnology companies are developing many new drugs that are expected to revitalise the field of cardiovascular therapy. According to one survey, cardiovascular drugs in the US are now an annual $8.7 billion business - outstripping all other drug categories. With sales growing by a robust 9.4% yearly (expected to reach $13.5 billion by 1997), cardiovascular drugs clearly represent a big market getting even bigger. One segment of that market - innovative antiarrhythmics - enjoys the greatest short-term growth. This review highlights recent advances in research and development of this promising group of cardiovascular drugs.