Chapter 13: Cardiac Arrhythmias

All antiarrhythmic drugs (AADs) are proarrhythmic. Cardiac arrhythmias range from benign to lethal. Antiarrhythmic drug therapy should be individualized to patient response while minimizing adverse effects. Many AADs are associated with significant drug interactions. Nonpharmacologic therapy is an important treatment modality, particularly to prevent life-threatening ventricular tachycardia and ventricular fibrillation and to maintain sinus rhythm in patients with atrial fibrillation (AFib). Treatment of AFib should always include an assessment of antithrombotic therapy to reduce stroke risk. In the absence of a contraindication (e.g., major drug–drug interaction, mechanical heart valve, or mitral stenosis) direct-acting oral anticoagulants, such as dabigatran, rivaroxaban, apixaban, and edoxaban are preferred over warfarin to reduce the risk of stroke.