Anti Arrhythmic Drug with clinical use of drug and epidemiology

1. • YASEEN SERAJUL ISLAM –151
• MD. RUBAYET FERDOUS – 151
• KAMAL UDDIN – 151
• AMZAD HOSSEN – 151
• MD. MAZHARUL ISLAM – 161

2. Introduction

3. Definition:
Also called Dysrhythmia
– Disturbances in the
 Heart rate,
 Rhythm,
 Impulse generation or
 Conduction of electrical impulses
responsible for membrane depolarization
– These disturbances can lead to alterations in
overall cardiac function that can be life threatening.
Antiarrhythmic drugs:
– Compounds used to prevent or treat cardiac arrhythmias
Basic Introduction of Arrhythmia and Anti-arrhythmic drug

4. Causes of Arrhythmia
Root causes:
Causes of Arrhythmia
Arrhythmias may be caused by many different factors, including:
•Coronary artery disease.
•Electrolyte imbalances in your blood (such as sodium or potassium).
•Changes in your heart muscle.
•Injury from a heart attack.
•Healing process after heart surgery.
•Irregular heart rhythms can also occur in "normal, healthy" hearts.

11. Class IV: Ca2+ channel antagonists
(verapamil, diltiazem)
Classification of Anti-Arrhythmic Drugs
Class I: block Na+ channels
• Ia (Quinidine, procainamide, disopyramide)
• Ib (lignocaine)
• Ic (flecainide)
Class II: ß-adrenoceptor antagonists
(atenolol, Sotalol)
Class III: prolong action potential and prolong refractory
period
(amiodarone, dofetilide, Sotalol)

12.  Drugs used for supraventricular arrhythmia`s
– Adenosine, verapamil, diltiazem
 Drugs used for ventricular arrhythmias
– Lignocaine, mexelitine, bretylium
 Drugs used for supraventricular as well as ventricular
arrhythmias
– Amiodarone, - blockers, disopyramide, procainamide
Classification based on clinical use

13. Historically first antiarrhythmic drug used.
Clinical Pharmacokinetics
• well absorbed
• 80% bound to plasma proteins (albumin)
• extensive hepatic oxidative metabolism .
Uses
• to maintain sinus rhythm in patients
• to prevent recurrence of ventricular tachycardia
Adverse Effects- Non cardiac
•Diarrhea, thrombocytopenia,
• Cinchonism & skin rashes.
Drug interactions
• Metabolized by CYP450
• Increases digoxin levels • Cardiac depression with beta blockers • Inhibits CYP2D6
Quinidine

14. Sotalol is a drug used in individuals with rhythm disturbances (cardiac
arrhythmias) of the heart,
and to treat hypertension in some individuals.
• It is a non-selective competitive β-adrenergic receptor blocker
• this dual action, PR interval and the QT interval.
Mechanism of action
 Sotalol hydrochloride has both beta-adrenoreceptor blocking and cardiac action potential
duration prolongation antiarrhythmic properties.
 Sotalol hydrochloride is a racemic mixture of d- and l-Sotalol.
 Both isomers have similar Class III antiarrhythmic effects,
 Sotalol is non-cardioselective.
 Sotalol does not have partial agonist
 In children, a Class III electro physiologic effect can be seen at daily doses of 210 mg/m2 body
surface area (BSA).
Sotalol

15. Indications:
 Ventricular arrhythmias Like other beta-blockers,
 sotalol is an effective antihypertensive agent and it is also suited for
combinations with other antihypertensive drugs.
 Because of the risk of hypokalemia
Adverse effects:
More common side effects are:
 Blurred vision
 chest pain or discomfort
 confusion
 lightheadedness, dizziness, or fainting
 shortness of breath
 swelling of face, fingers, feet, or lower legs
 tightness in chest
 wheezing

16. Verapamil
Cardiac effects:
It usually slows the sinoatrial node by its direct action.
its hypotensive action may occasionally.
It can suppress both early & delayed after de-polarizations
Verapamil blocks both activated & inactivated L-type
calcium channels.
Verapamil is a prototype drug. That Shows greater action on heart than on
vascular smooth muscle

17. Extra-cardiac effects:
Verapamil cause peripheral vasodilation
Its effects on smooth muscle produce a no. of cardiac effects.
Supra ventricular tachycardia is the major arrhythmia indication for verapamil.
Therapeutic uses:
 Also reduce ventricular rate in atrial fibrillation
 Occasionally useful in ventricular arrhythmia.
 IV verapamil in a patient with sustained ventricular tachycardia can cause
hemodynamic collapse.
Adverse effects:
 Verapamil have –ve inotropic properties.
 May be contraindicated in patients with preexisting depressed cardiac function.
 Verapamil can produce a decrease in BP

20. Condition of Arrhythmia about age factors in Bangladesh

21. The 2019 Gordon Research Conference (GRC), This 2019 GRC will
integrate topics ranging from the atomic, molecular and organ levels to
the translation of basic science discoveries to improve treatment
outcomes.
Highlights will include new applications of cutting edge technologies,
genetic and genomic mechanisms,
complex mechanisms regulating heart rhythm, and the future trajectory
of antiarrhythmic therapies.
Something new Invention are Coming soon

22.  New Concepts in Arrhythmia Susceptibility
 Advances in Cardiac Ion Channel Structure
 Neuromodulation of Heart Rhythm
 Transcriptional, Translational and Epigenetic Regulation of Heart
Rhythm
 Computational Prediction of Arrhythmia Risk
 The Future of Antiarrhythmic Drug Development
 Mechanistically-Guided Treatment of Arrhythmias
Prosposal of GRC

23. Prevention is better than Cure
we are at present only able to really cure cardiac
arrhythmias and to prevent sudden arrhythmic death in a
minority of our patients.
New developments are needed to bring us better results in
the future.
Conclusion

25. References