[New anti-arrhythmia agents].

Use of class-I antiarrhythmic agents (encainide, flecainide or moricizine) to suppress asymptomatic ventricular premature depolarizations does not decrease, but rather increases mortality from cardiac events after myocardial infarction. These patients should not be treated with antiarrhythmic drugs until improved survival is shown in a controlled clinical trial. In other clinical conditions such as symptomatic tachyarrhythmias class-I agents should only be used if the expected benefit outweighs the risk of an adverse cardiac effect. The development of new class-I drugs does not seem promising. Esmolol is the first intravenous and ultrashort-acting beta-adrenoceptor blocker that can be used to treat supraventricular arrhythmias in the critical care setting; in addition, it displays high cardioselectivity. Specific class-III antiarrhythmic agents including sematilide and dofetilide have been shown to be effective against ventricular tachyarrythmias in preclinical studies, but their clinical value remains to be established. Torsades de pointes arrhythmia is an undesirable side-effect closely coupled to specific class-III action that may limit their future use. The known pharmacological profiles and limited controlled clinical studies make amiodarone and sotalol promising candidates for drugs that may improve survival of patients at risk for sudden cardiac death.