Merino Jose L, Tamargo Juan, Blomström-Lundqvist Carina, Boriani Giuseppe, Crijns Harry J G M, Dobrev Dobromir, Goette Andreas, Hohnloser Stefan H, Naccarelli Gerald V, Reiffel James A, Tfelt-Hansen Jacob, Martínez Cossiani Marcel, Camm A John
Arrhythmia and Robotic Electrophysiology Unit, Cardiology Department, La Paz University Hospital, IdiPaz, Universidad Autonóma, Madrid, Spain.
Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Madrid, Spain.
Europace. 2025 Mar 30. doi: 10.1093/europace/euaf076.
The EHRA Practical Compendium of Antiarrhythmic Drugs (AADs) offers advice on these drugs, focusing on their clinical use and the global impact of cardiac arrhythmias. This document aims to provide practical instructions to clinicians in arrhythmia management through pharmacological strategies. The compendium highlights persistent challenges in arrhythmia treatment, including clinical constraints, procedural risks, and the complexity of certain arrhythmias. Notably, atrial fibrillation is highly prevalent, and the demand for invasive treatment often surpasses the capacity of existing healthcare systems. As a result, pharmacological management remains essential. This is particularly relevant for patients with cardiac implantable electronic devices or channelopathies, where ablation is often not a suitable option. AADs play a pivotal role in these scenarios. The compendium introduces the ABC framework for AAD therapy: A (Appropriate therapy), for patients in whom AADs are the best therapeutic option, B (Backup therapy), as adjunctive treatment to invasive procedures, such as catheter ablation, and C (Complementary therapy), in combination with other therapies. The document provides detailed insights into the mechanisms of action, efficacy, safety profiles, and drug interactions of each class of AADs. Additionally, the compendium covers practical considerations, including initiation, combination strategies, monitoring, follow-up, special populations, and adverse effect management, with an emphasis on proarrhythmia risk mitigation. It also explores the integration of AADs with other therapeutic modalities, promoting a synergistic approach to optimize patient outcomes. In summary, this compendium serves as an indispensable resource for clinicians, offering practical advice and evidence-based insights to navigate the complexities of arrhythmia management effectively.
欧洲心律协会（EHRA）抗心律失常药物实用手册就这些药物提供了建议，重点关注其临床应用以及心律失常的全球影响。本文件旨在通过药理学策略为临床医生在心律失常管理方面提供实用指导。该手册强调了心律失常治疗中持续存在的挑战，包括临床限制、手术风险以及某些心律失常的复杂性。值得注意的是，心房颤动非常普遍，侵入性治疗的需求往往超过现有医疗系统的能力。因此，药物治疗仍然至关重要。这对于植入心脏电子设备或患有通道病的患者尤为相关，因为消融通常不是合适的选择。在这些情况下，抗心律失常药物起着关键作用。该手册介绍了抗心律失常药物治疗的ABC框架：A（适当治疗），适用于抗心律失常药物是最佳治疗选择的患者；B（备用治疗），作为侵入性手术（如导管消融）的辅助治疗；C（补充治疗），与其他治疗联合使用。该文件详细介绍了各类抗心律失常药物的作用机制、疗效、安全性概况和药物相互作用。此外，该手册还涵盖了实际考虑因素，包括起始治疗、联合策略、监测、随访、特殊人群以及不良反应管理，重点是降低致心律失常风险。它还探讨了抗心律失常药物与其他治疗方式的整合，倡导采用协同方法优化患者治疗效果。总之，本手册是临床医生不可或缺的资源，提供实用建议和基于证据的见解，以有效应对心律失常管理的复杂性。
