Antiarrhythmic drugs are used to suppress abnormal heart rhythms such as atrial fibrillation and ventricular tachycardia. They can modify impulse generation and conduction in the heart. Cardiac arrhythmias involve abnormalities in the rate, regularity, or origin of the cardiac impulse or disturbances in conduction that alter the normal sequence of atrial and ventricular activation.

1. Antiarrhythmic Dru1
gs

2. A hyth
•
,
rr ·.·
·
...•
....··m1a
• Heart condit:
io1
n where d1
isturbances in
0
Pacemaker 1
im1
p1
ulse fo,rmation
° Contraction iimp1
uls1
e conduction
° Combiln1
ati01
n of th1
e tw1
0
I
R,
es,u1
lts in ra.
te a.
nd/or ti1
mi1
n1
g of contraction of
h rt 1
1 th t · Ill n·· ,
. t t I■ nt ·
1 ea, .musc,el ·1 a._ 1s1 1nsu· 1c1e,n o ma1 _
:
a1n
n1
01
rmal cardiac output (CO)

3. l'f lhe
arrhythmia
arises,lrom
al,
ria, SA nod.e,
or AV node it is
called
su raventricu1a
r arrhy1hmia
If lhe arrlhythmia
arises.from 1
llhe
ventrioles i1 is
called ventricuiar
arrh.-:hmi1
a
Caus.les,of
arrhythmia
arteriosclerosls
Coronary
atlef'Y s.pasm
Haan block
~rdai
ischemia

4. Mechnlsms ofArrhythmogenesls
Au1 □im,alic
rhythms
1-Abnormal
impulse
eneralion
De,1
,ayed
Enhanc-
ed
.
normal
au'loma.Uc~
Ectopic focus
aft,
erdepoIariza!ion
1
1 -~- - -
~= ~ r AP sises from siias
p frcm ,
SA nbda L
a1t1w- 'lhan SA.noda
-~~~-~~~ ~@al L ~ ~
JI 1t1a 11:1, ~ - - --- t:rtJ:!car fu:11
Triggered
rhythms
Early
afterdepolar12.alion

5. 111
degree
1
C1
ondudion
lblock
2-AbnOrmal
condutll,;;1111
Raan'lry
CirPJS
r
mowement !
Reflection

6. Pharmacology
Rh'thm disord1
er~ a·re
-
trealed with
111edication1 that
■orm.a'li.z·e the heart
rate by aflec'fin,g lbe
n,enous system tba,
I
con.trols the heart
r:
a·te.
fl Medlcatlens for:
. .· Rll'Tlll1I
DISORDERS
.· •bet■ block.
en
.....-.-..•'aldam chan.nel blockers
I
Mr.S.SEETA RAMS,WAMV~
. M.Plw'rm
s

7. Antiarrhythmic drugs
Mosl anliarrhylhmic d1
rug1
s are 1
P1
ro-arrtr1thmic (1
promote arrhythmia)
•They are classified accordiill:J 1
10 Vi!uru~an LV1lua1n into tour classes acoording1 lo their
I 1
effects 0 n the cardiac actianpolential
I I
Na• cha,nel blocker
II ,
JI blocker
UI
IV Ca·
.., ch,
&11nal blocker
---------
Change ttne ,
slope ot
phase 0
J1
haart rate and
condJction velocity'
1. f action po,
tenlial
duration (API
D) or
1
ellective r1
at·radory
period (EI
RP).
.
2~ De,
la,
y
repollariizati'on..
Slowing lhe,rate of rise
in phase 4 ol SA
node(:
sIida 1,
2)
Can abdish
tachyarrhyth1
m'ia
1
causedlby reentry
,
cimuit:
Can indirectly alte1
r
I
KandCa.
oondld,
ance
lmib~ reenitry
1
lachycardia
~
1
conduction1vek>city
in ,
SA and ,AV nadle

8. A-RHYTHM -IA
D~fi1,itio11- Arrhythmia is d1
ev·iation 1
ofh.
eart from..nonnal.
RHYTHM.
..~ 10 oh 1ul 11ut..lP
f-4.• n:.t- ..-1.!:1, !, 1(.~lu-1 t M.1t.l-!J
RHJ1
THA1
I) HR- 1
60-100
2) Should ori,
gin from SAN
3) Can:liac i.:m.pulse s1
hould p,
r~pagate,thrioulfr' v~r·~-~~
normal condu.ction pathway with normal!ve.1
locily~
A heartbeat that is too fast is called Tachyca1
rdia.
A heartbeat that is to,
o slow is called bradycardia. 3
Mr.S.5EETA.RA~ISWAMY.'! M.P.hlrm

9. - - ~ -
l·lea1
·1
Willl Wll ltt.lt ■ I. ltll ._tnml•ii't--•t
bl- .C lhl SA nCldl. kliealMI • h na,11
,li4f1Vffi1
1 11w $A l'W.ldlJ ~bill 1M ••, •Kat
~inplbeitlaMtlliilmi1e.MCJ..,...._dh .
r:11 111:Mt. TN llltielflelll m--, _,._
ffil'ou&h me Wlllts d h ... 111C:r Ullla
ll!llmlOCOMracl.
~ CA,
YJ NDdit
Tht AV 1!1C11R • loemild ...,._. ._ Mm
iftil!I ~ ,
ancl a:•...•...11111
- • 11w tlii.l!UllCII ....... ..,_. • .,._..
. . ¥lrlliilll:.I. , ...I
...,.,.,.....
II... ID COitliilCJ tl_
..D"'Wi h ¥irl~I,CID.
NI&~.... ......_
r,__,,1,w, or111111a.• _. ll'lill ifflDUIM
.. u. fflUKulW _,,. oil .. --biCln
ad mu-tlllll, lhlm ID cailHiCl. Tr.a
eDllfqO-• D NS 1
Nood •I QI lht h J_ "I
ID a. hl•a and baap.
...............,............
llftll c,11 ._.._,C lu.
---1
-·
Mr.S.SEETA RA MSTAMY., M..Phirm
p ~
-,
• •

10. Anti-arrhythmic agents are a group of drugs that are used to
suppress abnonnal rhythms of the heairt (cardiac
arrhythmias), such as atrial fibrillation, atrial!
flutter, ventricular tachycardia, a1
ndlventricular fil
brillation~
OR
The anti-arrhythmic drugs can1m1
odify impulse generation
and conduction.
Cardiac Arrhl'ythm1
iasis are ab1
normalities in the irate, riegul,
arity
or site 1
0 1
f·1
D'rig1
in 0 1
f the cardiac i1
mpulse or a dlisturbanoes in
condluct1
i1
0n of tihe impu1
ise su1
ch thiat th,e normall seq1
ue1
nce 1
0f
activation 1
0f 1
B1
tria andlventri1
cles are 1
alt.
1
ered..
~11'.'S.S.EFrA.R.Aa
MSWAMY·., ~i.Plu.111111

11. Co1
aduction System
.......
,Slnaatrlal nodeI
~
Atrial ayncytluml
+
Junctlanal fibers I
♦
Atrloventrlcular node)
♦
A-V bundle I
+
·
Bundle branchesI
~ I
PuliclnJe flbere -
f
Ventricular ■yncyt1umJ
... - - -----,,r
...... Iii . ..
Mr.S.SEETA RAMS,WAJdY... l'JLPh.irm

12. I - -
1 C1
LT
SES: He1
arl Arrhythm1
lla .
Causes ol Hearl Anhylhmia ar Whal
Causes Abnormal Heart !
Rhythm?
- ---
- ,-
- . _,, o ·ita Pl ___ : ii .._ lo a pffot ·
:qtta1c1
kf
o-
~
'=-•• con, ~ :__ 1g, ,J_
l{e-,
canjfo,nyio·P-Qtb.~
em. ,
aft _
___-~,, ~,.:1l•J.1•·
~
~ j , • _fl'~-~•Ion · -
DIC!~-~;~:_
jlf~•
!~-
H. I.-;;--"~~~---~,
Hr ,- _- ~
ffi~~·
:t4~.
·
1r:o _ :;c,o«-~u:-·.---
A'fc,
o1101 1
oi·.·edtl!efn•q
o -u
. . . - -~
-
,-.,-.r;;. -- .. - -
-
AttClf•all'ona~I ~fii111~u~t·!· = i· ..-r=. 1
-">.
~
.-~c-
as·stv• 1
l!
lra:1·
1-· , ~ - • 1
c,!
-:art~f~ .dlG1
SS•·1: ;
0!' ;,m~-dl~IUi,n(~I~ !:. ·• " •• ,
,.•
c:an;1
crls1
0 -
c1
aus1• H•afl!Arfftr,_111rn11'a,,. ii,._
~:.r1011ft die! -I a1;1.
1lntim•n.t,, 'i:.., .' - ' -~ -~
an ·
Q11,o ,c:1ou1-■ ittwafl' ·
1
~
1
n hytt,mlas _
._
!l'•erl11c1
a11'hoc:
IQ
Mr..S.5EE'fAIIA.115"A.~ll '- M.Pllaf.
m
..,
I
H

13. The h;eart''s paclemaker causes regular contracting of
1
the
myocar·
dium resultiing in a regular·he1
arl:beat ar pulse.
Contraction Phases
•Polarizalian.(restlnl) •·Rlpalarlatlon (recbaralnl)
'Mr~
S.Sl!ETA RAMSWAMY..•.M.Phlrm

14. Clllass I':
•:• Anti-arfhyth,
mic drugs act: by blocking
v1
altage-sensi,
tive sodium dhanne1
ls via1the,
sa,ne mechanism as liac:al anesthetic"
·> The decreased rate· 1
of entry of sodiumr
slows1
'the rate of rise of Phase Oof the actic>n
patentia1
I~
I
H2
N .
I
- I Procainamid,c
Mr.S.SEETA,RAMSWA'~lY... M.Ph1u1n
• r
CJM.s '.IA: c .g . Qtrln1cli1•u~
- f~LO "-a"•Channel f~
- "'fRP
•
1
0Ms 18: e g , ltdo :1 n'!
- ~ N.fii•-<~ I ) ~
- '"' ERP
• ,
Qass 1C: e.g ... fiecn n1
dc
- ~ming r.Ja.•
m
.,~ b l ·
- _, EJW
'
'
()uiniid ine u

15. - •
1
•,
A fluttering in.·your chest..
I_ ' '· .·. I . . . ..... .. I - ,- • . • . .. • ~ '. I . .
■
A I 'h -'b - (. h d. )
. .rac~ng ._
eart...eat .tac__.
ycar _
a
1
•A slo
.,_ .
·b.e·artbe
. ·at :(.
·bra
.
,·d
·, -C
•-
ardi
·. ·.al·
)
.w - - . . - .y -- -.
• I • •
•Ch.
est pain.
1
•Shortness ofbrmth.
■L~ -hth
- -d dn---
. -
1g · 1
ea•e .·. 1
ess.
•n·.. .-··...
.1zz1.ness1•
1
•Fainting (syncope)
Clii! il!!!!iii!illl - -- - .
...... II . iilill l..: ·:::.71iliillilll
---- u
lliii. ■ MD [lli!!I l!illliilll
. . . flJ:tllillii
- -
--
t
c-......-111...-r.-
l.lllliil' !allll111 - ·l!illiili
tr - I
- - illliillil'II
I ,i-..
,...-1
-.,..., TP-1
- .._
rt q ....
- &zJ,
,__
. --
,
,,_
I e 111111 1
l!iiill ~
• · liiiiil . - .
Mr.S.SEETARA.MSWAMY•;,, M..Pbam1

16. ,ANffARRHYTHMI
IC
DRUGS
CLASS I
CNa1
"" channi!lll bl _-_ - I
- O&i4flSI.-"""'- IIIV
R ,acal,_,,._ UC1
&#"~,,.,
.........,,.
#'f;uc::nfn-s,Nia 1
tllU
lflrop.••--n1
• t-U:J
,QuJftM.,. ,RAJ
'li:N:o-lft-idlit,"'"'
Cl.AUii
Cll- ad...n a • ~
lill...._,,
CLASSllll
(Ir" cllann■li W.ch■ r■I
Am,.Nillwn•
U'l'll■R ,ANTI-
A 1
RRHYTHMIC DIIUGS
- - -
1
1
C1
l--'ASS1
.
IF'l 1
Ci.Tlf)N
I
I
The anti-arrhythmic d1
rugs can be
classifi:ed a1
ccordin1
g to their
pr1
edominan·
t effects on the action
potent:ial.
The Va1
ugh1
an1William's
C1
lass1
ific,
at1
ion 1
of AAD is based 0 1
n
thei·r effects on1the 1
car1
diac
action potentia1
I (AP).
10
,Adl!n••--
01,,.._ Mr.S.SEETA RAM'S1
WAM"
Y.•lW.Ptutrm

17. Procainamide Synthesis
soc~
0~
P-nltro l
be~I,
dllnrlde
..
P~tr,
e bfnalltadd
01
•1
·
_· ,~Hi SnJHCl
·----C-NHCH2C~N ·• 0iN
Ralactlt111
~Hs
Pl"ilXai n■midr
Mr~
S,.SEFfARAMSWAMY•• M.Phann

18. cr
LAss-ml
•It mainl~ acts]by b:
loclking K+ channels.
•It increases the refracto1
ry'peri1
od.
•It increases the dur
ration ·
withou,t
affecti1
ng1phase Oand res't~ng membrane
potentiat
,
c1n1m::
Palalai.m (K) cb■■■el blKHn
1
(llepol•lzallan pNl1
aa1•tonJ
Amiudnmni:
Jbulilrde
Dof~tilide
Bn:1ylium
CH~
c
-·H1
·, 2 : 3,
1
0CH~H2NC1
H~H3
I I. I I •HCI
M,.s.sEETARAMSWA.hly .• M.Plt1ntli

19. Cla5s D:
'5-adl
renergic antagonists:
•These drug,
s,di1
minish Pha1.se 4
depolarization, thus de1
pressing auto.,maticity,
prol,
anging AV condudioni,
, and decreasing
heart rate and co·ntra,ctility.
1
•Class Da,
gen·
ts are useful 1
in1
treating tachy,
-
anhythmias car
used b1
y increased sympathetic
,
activity,.
,■They· ,
are also r
used far atrial flutter and
fibri1
lla1
tion1
.
and for .
AV-·nodall reentrant
tachy,canlia. 'fr
H
•. ,&;& - QCH1
CMCN1
2
,NHCMCCH1
)
1
. .
. .
. .
. .
. .
. .
. . . . . .
- -
OUI II:
Beta blacken
Propranolol
Acebulalol
Solalol
Esmolol
Timolol
Metoprolol
Atenolol
1iher■1peutlc U■e
at
II-Blacker■,
ll-lypertension1
Angina
lftAyocardial i1
nfarction
Arrh1
ylhm1
ias
!
Heart.lailrure
prop•
rano ]ol Mr.S.SliETAI.A'M:SWAM,Y.• M.Pharim
IJ

20. ............
C'1
UNICAI
L USES,
: P~
llaekarl.
Alraplna
Yenqmml
1
0-iSZWI
..----.---,~ AMII. ~
--
•Id I
1
•Sodium1cha,nnel l
blocbrs are a1
lso
used as local an1
esthetics and
antic01
nvu1
lsa1
n1
~
•
1
Procainamide can b,
elused to
b1
eat atrial filbrillation in ·
lhe sett'ing
af Wo1
lff-Parkinson-""'11
ite
~ ,
ndr1
ame..
•Supra1
-wnlric:ular arrhythmias"
1
•lNadal and ventricular,arrhythmia~
•
1
I
Refracta1
ry ventria1lar arrhyd,mias
- AVlllllla
~
~
I
Dligull"
'lnlplmil
I
Dlbmm
P,.1r.S.SEETARAMSWAMY.~M _
Pfal!lffl1
...
ca-l•illl•&--1
I
~
lfk- ....
Pmpai■a■
Arnladral•
Vllllr!d•
I
LJdocai•
1
fUWiOCalNI
"'8:d1w
~

21. Clllass w~
Calciu1
m-cha1
nnell b1
lockers:
17hey 1
decrea1
se the inwant current
1
carr·ied by calcium, resulti1
ng in a
1
decrea1
sed rate of Phase-4
spontaneous depolariza·tion.
.·· OCH
. --- - - 3
OC'OCH3
H~O
I
I ~
( ) , ii'Iira/t 111
I ,
Clan IV:
Cakl,11111 (Ca+!J1dl••f1J 1
bJochn
V1i..-mpamjl
Di1
1illl1:m
T1
he1
rapeutlc Use of
Calclum-Cbannel
B1
lockera
•Hw,erlension
(systemic ,
& pulmona1
ry)
•Angi1
na
•~hmias
H~
•
1 HCII
OCH:1
1
CH:3
I
NI OCH:1
OCH3
15
Mr.S.SEETAJlA MSWAMY., M.Pbmm

22. -
Other drugs used in Tachy-arrhythmias
I~ lnhlbill1 AVconduction.
Tha dlura11on d elacl ls1
INl lh,
an 1
80 a.
•1
ulldll ,
I an Lv. bolUI 1
ln sv .,.,.r11
I ·_ n .~ QRS r: -
~
•AD1
Rs:bra,
drcardla, AV block.I
-
'
II
-
Digox.in raducaa cond1
udlon1
through1h11
AV IIGde and is useful in Iha c:onbol of
atrilll flutterand llrill1
•r11at1on1
,
Mr~
S.S.liETARA.MSWAM Y.., M.Phl.rm
HO
16

23. Side Effects Associated With
Antiarrhythmics
1
• Worseni1
ng a11rrhyth1
m'ia1
s
• Alle1
r1ic 1
'1ea1
ction
1
•
1
Chest p1
ain1
F Iii ti'
1
• _ a11
n_ing
1
• :
Swelling01
f thieJeet 01
r legs
1
• Blurred 'Visio:
n
1
•
1
:
Sho:
rtnes-s ofbre,
aith
,
. Abnorrnallr fa:
st heanbe1
at
• Abnonnall¥ s,
low heartbe1
at·
Mr.s.SEETARAMSW,AMV. , M.Phirm UJ

24. Clas I:
Sodium (11)1
chllHIII,blacbrl
(Membrane,dlprlu1nt dnlpl
Cuinidjne -
Procanamide
Oisopyramide1
UdocaJne
Ph~~n
,-xf1
le1rne
Fecaln~e
Tocanaiele
Propafenone
P«lrimine
auan:
Betablocken
Propranolol
Acebutalol
Sotalol
Esmolol
Timolol
Metoprolol
Alenok>I
Clasi m:
P11Dhl11lu1
m (K) channel bloekcn
t.
Rlpalarizaliun pr:olong1.fon)1
Antiudaronc
lbutilid1:
Dofelilide
BrctyUu:m
Cius R':
Calcium 1
(Ca+!) 1
c•_nnel blacken
Verdpamil
Dilliuzem
Clan 1:
Variable IIH!dlanhm
AJcr1n~lll1
:
D1
i~u~in
flugncsium ~ulfate
Mr.:S..S:Et:TA!RAM·S"
AMY
- '·• p
· 1..- =
, a, M ... 1
11A.UU
21

25. C
PACEMAKER
A pac·e11111ker is a small device tbars placed in the chest or abdomen to
he:
Jp conlm.l .ab:
nonnal heart rhythms.. lhis device uses low-eneQJY electrica.l
pulses to pro,
mpt:the heart to1
beat at a.normal rate.
Pacemakers are us·e<I to treat arrhythmias. Arrhythmias are problems with
·
the mte er mythm ofthe heartbeat
Mr.S.1
SEETA RAMSWA.MY.. M.Phl·nn