Clinical Applications, Limitations, and Emerging Therapeutic Strategies of Antiarrhythmic Drugs

Arrhythmia is an abnormal cardiac rhythm disorder caused by abnormal excitation of the sinoatrial node or by excitation originating outside the sinoatrial node. At present, four major classes of traditional antiarrhythmic drugs, including sodium channel blockers, β-blockers, potassium channel blockers, and calcium channel blockers, are predominantly used in clinical practice. Sodium channel blockers are used to treat atrial and ventricular arrhythmias, as well as long QT syndrome and short QT syndrome. β-blockers are used in the treatment of tachyarrhythmia and acute ischemic stroke. Potassium channel blockers are used to treat tachyarrhythmia, heart failure, cardiac arrest, and myocardial hypertrophy. Calcium channel blockers are applied in supraventricular tachycardia, coronary artery spasm, and atrial fibrillation. Nevertheless, these drugs also have significant limitations, including considerable side effects, restricted target populations, and failure to cure hereditary arrhythmias. These limitations have led to numerous clinical challenges and solving these problems remains an important issue. New antiarrhythmic drugs can be developed along four directions: funny channel blockers, targeted drugs, gene drugs, and Purkinje cell gap junction blockers, all of which can warrant further exploration. The value of this review lies in overcoming the limitations of the four classes of traditional drugs, summarizing new therapeutic drugs for treating arrhythmia, and proposing novel ideas for antiarrhythmic drug development.