Advances in Antiarrhythmic Therapy

THE APPROACH to the management of disorders of cardiac rhythm has undergone major changes in the last ten years.1,2The early experience with surgery and with pacemakers suggests that these modes of therapy hold much promise; however, it is unlikely that they will have a major appeal for the largest numbers of patients needing antiarrhythmic therapy.1Drug therapy is therefore likely to remain the mainstay of long-term antiarrhythmic treatment for both supraventricular as well as ventricular tachyarrhythmias. Clinicians have long sought the "ideal" antiarrhythmic agent, one that has a wide spectrum of therapeutic efficacy, is potent, well tolerated by the patient while having little or no side effects, but with pharmacokinetics appropriate for long-term prophylaxis. Although the discovery of such a compound still appears elusive, many new drugs are now being evaluated in the United States.3,4Their investigational use is growing, and some are likely to be approved