Antiarrhythmic Drug Therapy in Cardiomyopathies: A Comparative Synthesis of Guidelines and Consensus Documents

Figures

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  Fig. 1. PRISMA flow diagram of study selection. Flow diagram summarizing record identification, screening, eligibility assessment, and final inclusion of clinical practice guidelines and consensus documents. Overall, 51 records were identified, 36 were screened after duplicate removal, 21 underwent full-text assessment, and 11 documents were included in the qualitative synthesis. Created in BioRender. Palermi, A. (2026) https://BioRender.com/sun63ai

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  Fig. 2. Antiarrhythmic drug therapy in cardiomyopathies: from phenotype to clinical context. Summary of preferred, alternative, and avoid/restricted antiarrhythmic drug strategies across major cardiomyopathy phenotypes and selected clinical scenarios, with indication of the predominant arrhythmic burden across phenotypes. AADs, antiarrhythmic drugs; ADHF, acute decompensated heart failure; BB, beta-blockers; HCM, hypertrophic cardiomyopathy; DCM, dilated cardiomyopathy; NDLVC, non-dilated left ventricular cardiomyopathy; ACM, arrhythmogenic cardiomyopathy; HFrEF, heart failure with reduced ejection fraction; SHD, structural heart disease; LVEF, left ventricular ejection fraction; VT, ventricular tachycardia. Created in BioRender. Palermi, A. (2026) https://BioRender.com/ze86y8j

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  Fig. 3. Central illustration: key messages on antiarrhythmic drug therapy in cardiomyopathies Summary of the main messages emerging from the comparative synthesis of guidelines and consensus documents. Antiarrhythmic drug therapy in cardiomyopathies is primarily safety-driven, only partly phenotype-specific, and mostly adjunctive to device-based and interventional strategies. Drug selection should consider arrhythmia burden, LVEF, myocardial scar, and clinical context, with special scenarios such as pregnancy, electrical storm, and athletic participation requiring tailored decisions. AADs, antiarrhythmic drugs; ACM, arrhythmogenic cardiomyopathy; DCM, dilated cardiomyopathy; HCM, hypertrophic cardiomyopathy; ICD, implantable cardioverter-defibrillator; LVEF, left ventricular ejection fraction; NDLVC, non-dilated left ventricular cardiomyopathy; SHD, structural heart disease. Created in BioRender. Palermi, A. (2026) https://BioRender.com/p62jlvj