Why the study?
Many common clinical scenarios involving antiarrhythmic drug use are understudied and lack clear guidance for clinicians.
This HRS/PACES scientific statement provides practical, consensus-based guidance for prescribing antiarrhythmic drugs in complex, understudied clinical scenarios where randomized trial data are lacking.
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Enables class 1C use in congenital heart disease and PVC cardiomyopathy after excluding ischemia; extends CAST findings to understudied populations.
Antiarrhythmic drugs can be an important treatment option for patients with heart rhythm disorders, but not all patients and scenarios are represented in trials related to antiarrhythmic drug use. This Heart Rhythm Society scientific statement identifies common clinical scenarios for which little guidance exists, at least partly because they are understudied. It also provides as much practical advice as possible, sourcing available evidence and the clinical proficiency of a diverse group of experienced clinicians, and provides the rationale for each recommendation.
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Morin et al. (2026) conducted a review in Arrhythmia (understudied clinical scenarios). Antiarrhythmic drugs (AADs) was evaluated. Antiarrhythmic drugs, particularly class 1C agents, can be used in understudied scenarios such as congenital heart disease and PVC-mediated cardiomyopathy provided that underlying myocardial ischemia is rigorously excluded.
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