Antiarrhythmics Management During Electrophysiology Procedures: A Stepwise Approach

This review examines the protocols and rationale for stopping antiarrhythmic drugs (AADs) before interventional electrophysiology (EP) procedures to establish a drug-free baseline, ensuring diagnostic accuracy and procedural success. The review provided a detailed analysis of procedure-specific AADs washout requirements for supraventricular tachycardia, atrial fibrillation, and ventricular tachycardia ablation, and a comprehensive, drug-by-drug guide to calculate washout periods, based on pharmacokinetic and pharmacodynamic principles. This guide details the half-life, metabolism, and elimination pathways for all major AAD classes, and gives specific, actionable recommendations for adjusting wash-out times based on patient-specific factors, including age, renal function, and hepatic impairment. The aim is to provide clinicians with evidence-based guidance for standardizing AADs washout, thereby improving the safety and success of interventional EP procedures.