Physicians once found it convenient to think of cardiac arrhythmias as a sort of “itch” of the heart and of antiarrhythmic drugs as a soothing balm that, applied in sufficient quantities, would relieve the itch. During the past several decades, however, pioneering work has revealed many of the complexities of cardiac arrhythmias and of the drugs used to treat them. To the dismay of most reasonable people, the old, convenient viewpoint finally proved utterly false.
Indeed, in the decade since the first edition of this book appeared, the widespread notion that antiarrhythmic drugs are a salve for the irritated heart has been, appropriately, completely reversed. Every clinician worth his or her salt now realizes that antiarrhythmic drugs are among the most toxic substances used in medicine, they are as likely as not to provoke even more dangerous arrhythmias, and, indeed, the use of most of these drugs in most clinical situations has been associated with an increase (and not a decrease) in mortality.
This newfound respect for (if not fear of) antiarrhythmic drugs has been accompanied by the comforting murmurs of an elite army of electrophysiologists, assuring less adept clinicians that, really, there is no reason to worry about these nasty substances anymore. After all (they say), what with implantable defibrillators, radiofrequency ablation, and other emerging technologies (that, by the way, only we are qualified to administer), the antiarrhythmic drug as a serious clinical tool has become nearly obsolete.
It is certainly true that the use of antiarrhythmic drugs has been considerably curtailed over the past decade or so and that other emerging treatments have led to significantly improved outcomes for many patients with cardiac arrhythmias. But neither the widely acknowledged shortcomings of these drugs nor the dissemination of new technologies has eliminated the usefulness of antiarrhythmic drugs or obviated the need to apply them, when appropriate, in the treatment of patients with cardiac arrhythmias.
Consider that implantable defibrillators, while in clinical use for over 25 years, are still indicated for only a tiny proportion of patients who are at increased risk of arrhythmic death and are actually implanted in only a small proportion of these. Until these devices are made far cheaper, easier to implant, and more reliable than they are today (changes that would require dramatic -and thus unlikely- alterations in the business models of both the companies that make them and the doctors who implant them), they will never be used in the vast majority of patients who are at risk of arrhythmic death. And consider that ablation techniques to cure atrial fibrillation -the arrhythmia that produces the greatest cumulative morbidity across the population- have failed, despite prolonged and dedicated efforts, to become sufficiently effective or safe for widespread use. And finally, consider that with a deeper understanding of cellular electrophysiology, drug companies are now beginning to “tailor” new compounds that might be more effective and less toxic than those in current use, and that some future generation of antiarrhythmic drugs possibly even some of the investigational drugs discussed here in may offer a very attractive alternative to certain expensive or risky technologies.
It remains important, therefore, for any healthcare professional caring for patients who are at risk of developing cardiac arrhythmias (and not just the electrophysiologists) to understand something about antiarrhythmic drugs. Accordingly, this book is intended for nonexperts -the practitioners, trainees, and students- who are most often called upon to make decisions regarding actual patients with cardiac arrhythmias. The book attempts to set out a framework for understanding antiarrhythmic drugs: how they work, what they actually do to improve (or worsen) the cardiac rhythm, and the factors one must consider in deciding when and how to use them. Such a framework, it is hoped, will not only serve as a guidepost in making clinical decisions, but will also provide a basis for interpreting new information that comes to light on antiarrhythmic drugs and their place in the treatment of cardiac arrhythmias.
The book is divided into three parts. Part 1 is an introduction to basic principles the mechanism of cardiac arrhythmias and how antiarrhythmic drugs work. Part 2 discusses the clinically relevant features of the drugs themselves, including emerging investigational drugs that appear to show promise. Part 3 draws on this basic information to explore the treatment of specific cardiac arrhythmias and emphasizes the current roll of antiarrhythmic drugs in managing these arrhythmias.
Throughout this book, basic principles are emphasized. Accordingly, when a choice had to be made between simplicity and complexity, simplicity prevailed in almost every case. The author recognizes that some colleagues may not agree with an approach that risks oversimplification of an inherently complex topic. It is an approach, however, that reflects a deep-seated belief by keeping the basics simple, the specifics (clinical cases and scientific reports) can be more readily weighed, categorized, absorbed, and implemented.
Contents
Part 1 Basic principles
- Chapter 1 Mechanisms of cardiac tachyarrhythmias
- Chapter 2 Introduction to antiarrhythmic drugs
Part 2 Clinical features of antiarrhythmic drugs
- Chapter 3 Class I antiarrhythmic drugs
- Chapter 4 Class II antiarrhythmic drugs; beta-blocking agents
- Chapter 5 Class III antiarrhythmic drugs
- Chapter 6 Class IV drugs: calcium-blocking agents
- Chapter 7 Unclassified antiarrhythmic agents
- Chapter 8 Investigational antiarrhythmic drugs
- Chapter 9 Common adverse events with antiarrhythmic drugs
Part 3 Antiarrhythmic drugs in the treatment of cardiac arrhythmias
- Chapter 10 Basic principles of using antiarrhythmic drugs
- Chapter 11 Treatment of supraventricular tachyarrhythmias
- Chapter 12 Treatment of ventricular arrhythmias
- Chapter 13 Treatment of arrhythmias in pregnancy
Index
Book Details
- Paperback: 192 pages
- Publisher: Wiley-Blackwell; 2 edition (September 19, 2007)
- Language: English
- ISBN-10: 1405163518
- ISBN-13: 978-1405163514
List Price: $79.95