Antiarrhythmic Drug Therapy for Ventricular Arrhythmias: The Changing Role in the Modern Era

Antiarrhythmic drugs (AADs) can be powerful tools for suppression of ventricular arrhythmias (VAs).Historically, their use was aimed at avoidance of serious complications from the transformation of ventricular ectopy and non-sustained ventricular tachycardia (VT) into sustained VAs, causing sudden cardiac death.With expanding use of implantable cardioverter defibrillators for prevention of sudden cardiac death, the role of AADs for VA has become more focused on limiting recurrent VA and subsequent implantable cardioverter defibrillator therapies, reducing symptoms rather than eliminating or curing these arrhythmias [1,2].As interventional techniques in the management of VA evolve, the clinical use of AADs is also changing.In this issue of Cardiology, Apte and Kalra [3] summarize the use of antiarrhythmic agents for VAs, highlighting specific mechanisms and available evidence-based clinical guidance for commonly used drugs in the modern era.Antiarrhythmic pharmacotherapy is an area of clinical practice where significant uncertainties remain.Historically, clinicians grouped these agents using the Singh-Vaughan Williams classification, which organizes these drugs based on their physiologic effects on the cardiac myocyte action potential [4].This scheme does not integrate clinical context or application but despite attempts at revision remains the predominant method for conceptualizing AAD therapy.The authors highlight these limitations and provide a more granular approach toward