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Review
. 2023 Feb;23(2):52-60.
doi: 10.1016/j.bjae.2022.11.005. Epub 2022 Dec 21.

Antiarrhythmic drugs and anaesthesia. Part 2: pharmacotherapy

C J Kim  1 , N Lever  1   2 , J O Cooper  1
Affiliations
Review

Antiarrhythmic drugs and anaesthesia. Part 2: pharmacotherapy

C J Kim et al. BJA Educ. 2023 Feb.
No abstract available

Keywords: antiarrhythmic agents; arrhythmias; cardiac; cardiac electrophysiology.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Fig 1
Automaticity can be suppressed by (A) hyperpolarisation of the RMP, (B) reducing the slope of pacemaker potential (phase 4), (C) increasing the threshold potential, (D) increasing the action potential duration.
Figure 2
Fig 2
(A) Na+ channel blockers delay the point at which Na+ channels recover from an inactivated state, thereby increasing the effective refractory period (ERP). (B) K+ channel blockers prolong the action potential duration, increasing the ERP.
Figure 3
Fig 3
Summary of mechanism of actions of antiarrhythmic drug. AP, action potential.
Figure 4
Fig 4
Dissociation kinetics of Na+ channel blockers. Na+ channel blockers bind to Na+ channels in the open or inactivated states. Dissociation kinetics of the blockers and recovery of channels during diastole determines the extent of Na+ channel blockade. (A) Class Ia drugs have an intermediate dissociation rate and Na+ channel blockade is influenced by the heart rate. As the heart rate increases, the time available for drugs to dissociate from the channels during diastole is reduced. This increases level of Na+ channel blockade and provides heart rate-dependent steady state Na+ blockade. (B) Class Ib drugs have rapid dissociation kinetics allowing full recovery of Na+ channels before the next action potential. (C) Class Ic drugs have slow dissociation kinetics. The drugs do not completely dissociate from the Na+ channels even at low heart rate. This results in steady-state Na+ channel blockade even when the cell membrane is fully repolarised.
Figure 5
Fig 5
Common perioperative arrhythmias and management algorithm. Doses of commonly used antiarrhythmic drugs. AVNRT, atrioventricular node re-entry tachycardia; AVRT, atrioventricular re-entry tachycardia; BBB, bundle branch block; EF, ejection fraction; SVT, supraventricular tachycardia; VT, ventricular tachycardia.
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References

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