תרופות אנטיאריתמיות Antiarrhythmic Drugs. Prof. Amos Katz Cardiology Department

Size: px
Start display at page:

Download "תרופות אנטיאריתמיות Antiarrhythmic Drugs. Prof. Amos Katz Cardiology Department"

Transcription

1 תרופות אנטיאריתמיות Antiarrhythmic Drugs 0 mv קורס למת מחים, קיסריה נובמבר -80mv 2010 Prof. Amos Katz פרו פ ע מוס כץ Cardiology Department המערך הקרדיולוגי

2 נוש אי ה ו רא ה Pharmacology Pharmacodynamics Pharmacokinetics Use Dependency Classification Vaughn Williams Special Situation ICD / PM AF Model Brugada syndrome Pregnancy Sicilian Gambit Adverse effects: Cardiovascular Proarrhythmia Exacerbation of CHF Noncardiovascular

3 Pharmacodynamics Principles The effect of the drug on the patients

4 כלל י AA drugs cross the cell membrane and interact with receptors in the membrane channels when the latter are in the Rested Activated Inactivated Different association and dissociation rate constants Voltage and time dependent When the drug is bound to a receptor ionic channel can not conduct, even in the activated

5 USE-DEPENDENCE AA that exert inhibitory effects on the upstroke of the action potential At rapid rates of stimulation After longer periods of stimulation Depression of V max, is greater after the channel has been "used" (i.e., after action potential depolarization) Interaction of the AA with Open Inactive Little interaction with the resting channels class IB exhibit fast kinetics class IC drugs have slow kinetics class IA drugs intermediate With increased diastole time - slower rate a greater proportion of receptors become drug free

6 REVERSE USE-DEPENDENCE Exert greater effects at slow rates than at fast rates Particularly true for drugs that lengthen repolarization The QT interval becomes prolonged more at slow than fast rates This effect is opposite to what the ideal antiarrhythmic - precipitating torsades de pointes.

7 Use Dependency Use Dependency Open block Reverse use dependency Use dependency Closed block CL (msec) APD prolongation (msec)

8 Dronedarone a non reverse-use dependent effect on action potential duration Dronedarone 100mg/kg/day 80 p< vs. Control Amiodarone 100mg/kg/day APD90, msec Action potential duration Control AP duration longer than control at higher heart rates Frequency of Stim, Hz (Representing increased heart rate) On rabbit atrial APD90 (Action Potential Duration at 90% repolarisation). Sun W, et al. J Cardiovasc Pharmacol. May 2002;39(5):

9 Pharmacokinetics Principles Absorption, Distribution, Elimination

10

11 CLACIFICATION

12 סווג של תרופות אנטיאריתמיות Vaughn Williams Class I Na Channel blockers Ia I b I c Class II - Beta Blockers Class III K channel blockers Class IV Ca Channel blockers Digoxin Adenosine

13 The Sicilian Gambit A New Approach to the Classification of Antiarrhythmic Drugs Based on Their Action on Arrhythmogenic Mechanisms Circulation 1991;84:1831

14

15 Dronedarone

16 Mechanisms of Action of Antiarrhythmic Drugs Class I a b c C > A > B

17 Ia Ib Ic

18 Quinidine Quinidine: a valuable medication joins the list of endangered species Sami Viskin Europace 2007 Brugada syndrome congenital short QT syndrome Idiopathic VF AF? ICD?

19 Effects of Ito blockers 4-AP and quinidine on pinacidil-induced phase 2 reentry and VT in arterially perfused RV wedge preparation Yan, G.-X. et al. Circulation 1999;100: Copyright 1999 American Heart Association

20 Lidocaine Slows conduction: blocks the fast Na + channels rapid heart rate high K +, ischemia Decreases refractoriness Blocks Na + entry during the plateau phase of AP. APs of longer duration have greater window currents. Lido Therefore, APs of greater duration are preferentially shortened.

21 Mechanisms of Action of Antiarrhythmic Drugs Class II

22 Mechanisms of Action of Antiarrhythmic Drugs Class III

23 Class III Drugs that prolong repolarization Amiodarone Sotalol Dofetilide Ibutilide Azimelide Dronedarone

24 Dronedarone Displays Important Differences to Amiodarone Blocks Multiple K + Channels Na + Channel Blockade Sympathetic Blockade Ca 2+ Channel Blockade Overall Effects Slows heart rate Slows ventricular rate in atrial fibrillation Prolongs APD and QT/QTc Similar electrophysiological and antifibrillatory effects in ventricles and atria Reduces effect of EAD in M-cells and PF Reduces intrinsic and drug-induced heterogeneity of myocardial refractoriness Negligible proarrhythmia and may be anti-torsadogenic potential Elimination half-life 1-2 days Anti-ischemic and Antifibrillatory LVEF: Not Much Influence Pulmonary Fibrosis Unusually Long Plasma Half-life Thyroid Hormone Effects Shared Properties Amiodarone-specific properties, not shared with dronedarone Doggrell SA, Hancox JC, Expert Opin Investig Drugs 2004;13: Kathofer et al. Cardiovasc Drug Rev 2005;23(3):

25 Dronedarone has Key Structural Differences to Amiodarone Dronedarone O (CH 2 ) 3 CH 3 CH 3 SO 2 HN O(CH 2 ) 3 N (CH 2 ) 3 CH 3 O (CH 2 ) 3 CH 3 O (CH 2 ) 3 CH 3 I O(CH 2 ) 2 N CH 2 CH 3 Amiodarone O I CH 2 CH 3 Kathofer et al. Cardiovasc Drug Rev. 2005;23(3):

26 Dronedarone is a Multichannel Blocker Dronedarone Possesses Electrophysiologic Characteristics of all Four Vaughan Williams Classes Outward currents Ikr: rapidly activating delayed rectifier potassium current (ventricle) Iks: slowly activating delayed rectifier potassium current (ventricle) Ito: transient outward current Ik(Ach): muscarinic receptor-operated K+ current (atrium) Inward currents Fast sodium currents Calcium channel antagonist Gautier P, et al. J Cardiovasc Pharmacol. 2003;41(2): Doggrell SA, Hancox JC, Expert Opin Investig Drugs 2004;13:

27 Dronedarone possesses a very low proarrhythmic profile Dronedarone induces a homogenous effect on ventricular repolarisation Dronedarone effect on action potential duration shows no reverse-use dependency Dronedarone suppresses early afterdepolarisation induces by pure class III agents Sicouri S, Fund Clin Pharmacol. 1999;13:72. Sun W, et al. J Cardiovasc Pharmacol. May 2002;39(5): Varro A, et al. Brit J Pharmacol. 2001;133:

28 Dronedarone Clinical Trial Atrial Fibrillation LV Dysfunction 2a DAFNE ACT2401 2b EURIDIS/ADONIS 2c ERATO 2d ANDROMEDA 3a ATHENA 3b ATHENA Post-hoc Analysis

29 ANtiarrhythmic trial with DROnaderone in Moderate to severe CHF Evaluating morbidity DecreAse

30 Efficacy Vs. Amiodarone?

31 DIONYSOS Cardiovasc Electrophysiol, Mean duration 7 months. AF recurrence with dronedarone-63.5% compared with amiodarone 42.0% Premature drug discontinuation dronedarone 10.4% vs Amiodarone 13.3% Dronedarone had a better safety profile thyroid neurologic events lack of interaction with oral anticoagulants.

32 Meta-analysis randomized studies Amiodarone (A) vs. placebo (4) Dronedarone (D) vs placbo (4). Amiodarone vs. Dronedarone (1) Conclusions: Dronedarone is less effective than amiodarone for the maintenance of sinus rhythm Dronedarone has fewer adverse effects For every 1,000 patients treated with dronedarone instead of amiodarone ~ 228 more recurrences of AF 9.6 fewer deaths 62 fewer adverse events requiring discontinuation of drug.

33 Dronedarone - MULTAQ

34 Black Box Warning מולטאק אינה מתאימ ה ל חולי אי-ספיקתלב לב ח מורהאו או (NYHA FC III IV) בל בל תי-יציבה קראטינין-צפויה צפויהעליה עליהשל שלעד עד כ % ברמותהקר הקר אטינין טיניןבכ- בכ- 5% 5% מהחולים,המבט המבטאת אתהפ הפרעה רעה בהפרשה ט ובולריתולא ולא הפרעה גלומרולרית,שיעורהסינון הסינון הכלייתי (( (GFR; אינונפ נפגע. גע. עלייהזו זו מתייצבתתוך תוךמספר מספרימים ימיםולכן ולכןמומלץ מומלץלמדוד למדודאת אתרמות רמותהקר הקראטינין אטינין כשבועלאחר לאחר תחילת הטיפול ולהתייחסלרמת לרמת הקראטיניןכרמת כרמתהבסיס הבסיס החדשה. :CYP3A4 :CYP3A4 מולטא מולטא קעוברת עוברת מטבוליזםכבדי כבדיב- ב- 3A4 CYP.יש 3A4 ישלנקוט לנקוט זהירות ציטוכרום. בטיפולעם עם תרופות נוספותאחרות אחרות העוברות מטבוליזםבאותו באותו

35

36 Choice of AAD - Underlying Pathology

37 Vernakalant Blocks K+ Channels Important in Atrial Repolarization 0 mv I to I Kur Current IC 50 (µm) I to 5-30 I Kr I Kur 3-13 I KACh 10 I KACh I Kr 7-21 I Ks > ms I K1 > 100 Fedida et al. J Cardiovasc Electrophysiol 2005

38 Vernakalant Mechanism of Action Summary Multiple ion channel blocker I K, I Na Activity potentiated in atria during AF Converts AF rapidly and suppresses torsade de pointes in animal models Pharmacologic effects consistent with ion channel blocking profile 11/9/ :43 AM

39 Vernakalant Consistent Conversion Rates All Patients 52.9% * ** ** ** 51.0% 51.2% 47.0% 50.9% 14.0% 5.3% 4.0% 3.6% CRAFT ACT I ACT III ACT II ACT IV Vernakalant Placebo CRAFT: Dosing was 2+3 mg/kg; data represents % converted at 60 min post t last dose; AF duration hours ACT I, III & IV: AF <7 days ACT II: Post CABG and valvular AF study; AF duration hours * P= ACT IV: : A placebo group was not included in the ACT IV study ** P P

40 Class IV Verapamil Diltiazem

41 Mechanisms of Action of Antiarrhythmic Drugs Class IV 0 2 mvs time (msec) RECALL: INWARD Ca++ CURRENT CAUSES DEPOLARIZATION

42 Therapeutic Uses Treatment and prophylaxis of SVT Slows ventricular rate in AFib and flutter Electropharmacological Actions - Atrial Fibrillation Idiopathic Ventricular Tachycardia (verapamil)

43 Adenosine Interacts with A1 receptors present on the extracellular surface of cardiac cells Direct effects mediated through the guanine nucleotide Activating K+ channels (IK Ach, IK Ado) acetylcholine like Increase in K+ conductance shortens atrial APD Decreases atrial contractility In the sinus and AV nodes Indirect Antagonizes catecholamine-stimulated adenylate cyclase to decrease c amp decrease ICa-L and the pacemaker current If in sinus node cells slows the sinus rate -> reflex increase in sinus rate N region of the AV node, conduction is depressed Prolongation of the AH interval results, often with transient first-, second-, or third-degree AV node block Delay in AV nodal conduction is rate dependent

44 Adenosine SVT: -AVNRT -AVRT VT: - AT: -

45 DIGOXIN Na-K ATPase Na + K + M2 agonist Na-Ca Exchange Na + Ca ++ K + Na + Myofilaments Ca ++ CONTRACTILITY

46 Digoxin Autonomic nervous system Enhancing both central and peripheral vagal tone Slowing the sinus node discharge rate Shortening atrial refractoriness Prolonging AV nodal refractoriness Denervated hearts little effect

47 Ranolazine Noval anti anginal agent with Antiarrhythmic properties: Ion channel effect similar to chronic amiodarone Rx Reduced Ikr Iks Late INa ICa Suppress EAD & TdP MERILIN TIMI 36

48 לכל יצור הומאוטרמי מספר נתון של פעימות לב Sinoatrial I f current blocker a new target for heart rate reduction הממהר מקצר ימיו המאיט מאריך ימיו Ivabradine = Corlan BEAUTIFUL, SHIFT ההתוויה המ אוש ר ת ע"י מ שרד הבר יאות היש רא לי כ מו גם במדינות אח רו ת היא: Symptomatic treatment of chronic stable angina pectoris in patients with normal sinus rhythm who have a contra-indication or intolerance for betablockers

49 Pharmacokinetics of Antiarrhythmic Drugs Drug Bioavila bility. % Protein Binding % Time to peak hr Elimination ½T hr Elimination route Quinidine Liver Procainamide Liver & Kidney Disopyramide 85 variable Liver & Kidney Lidocaine Liver Mexiletine Liver Flecainide Liver & Kidney Propafenone Liver Amiodarone d Liver Sotalol Kidney

50 Proarrhythmia

51 Types of Proarrhythmia During Treatment With Various Antiarrhythmic Drugs for AF or Atrial Flutter According to the Vaughan Williams Classification

52

53

54

55

56

57 התחלת טי פ ו ל: א מבול טור י א ו בא י ש פ וז? אין קונצנזוס - :AHA חולים עם EF נמוך - באישפוז - לב תקין, QT תקין אמבולטורי התחלה אמבולטורית - מינון נמוך - מ עקב QT - מע קב א.ק.ג מודאג? באשפוז סיכון גבוה: EF ירוד,,CHF סיכון ל TdP נשי ם,,K Mg אנטי ב י וטי קה, א נטיה י סטמי ניקה

58 אפקט על ספ י קיצוב ודפי ב רי לציה

59 אפקט על ספ י קיצוב ודפי ב רי לציה

60 Drug Pacing Defibrillation עשוי לעלות בריכוז גבוה מעלה בריכוז גבוה Quinidine ללא אפקט מעלה בריכוז גבוה Procainamide? מעלה בריכוז טוקסי Disopyramide ) 0 או + ( Lidocaine מעלה ) 0 או + ( Mexiletine ) 0 או + ( * ) 0 או + ( מעלה Flecainide ) 0 או + ( מעלה Propafenone מעלה Amiodarone 0 מוריד Sotalol 0

61 אינטראק ציה הת אמה למחלו ת ר קע לא CV

62 שינוי מינון במח לות שונו ת או עם ת רופות אח רות

63 שינוי מינון במ ח לות שונות או עם ת רופות אחרות

64 שינוי מינון במ ח לות שונות או עם ת רופות אחרות

65 שינוי מינון במ ח לות שונות או עם ת רופות אחרות

66 New Approach to Antiarrhythmic Therapy Members of the Sicilian Gambit Circulation 2001;104:2865

67

68 Upstream Therapy

69 2010 European Heart Journal

70

71 השפעת ת רופות אנטיאריתמיות ע ל ת מותה JAMA 1993

72 AA drugs have not been shown to be effective for primary prevention (exception of BB) AA may be effective as adjunctive therapy under special circumstances Potential adverse side effects Both sotalol and amiodarone have also been shown to reduce the frequency of ICD shock therapy

73 Brugada Syndrome

74

75 ACLS 2005

76

77 WPW תרופ ו ת ה משפ יע ו ת על AP תרופ ו ת ה משפ יע ו ת על AVN תרופ ו ת ה משפ יע ו ת על AVN ועל AP

78 Amiodarone

79 תרו פות אנטיאריתמיות בהריון חלק מ ן התרו פ ו ת נכנ ס ו לש י מ ו ש בשל העדר דיו וחים על ת ו פעו ת ל ו וא י D - Amiodarone D - Atenolol B - Sotalol אחרים - C

80

81 Antiarrhythmic Drugs: Agents with occasionally beneficial side-effects effects תרופות אנטיאריתמיות הינן תרופות ב על ות תופ ע ות לוו אי אלקטרופיזי ולוגיים אשר ל עיתים גם מוע ילים

Antiarrhythmic Drugs

Antiarrhythmic Drugs Antiarrhythmic Drugs DR ATIF ALQUBBANY A S S I S T A N T P R O F E S S O R O F M E D I C I N E / C A R D I O L O G Y C O N S U L T A N T C A R D I O L O G Y & I N T E R V E N T I O N A L E P A C H D /

More information

PHARMACOLOGY OF ARRHYTHMIAS

PHARMACOLOGY OF ARRHYTHMIAS PHARMACOLOGY OF ARRHYTHMIAS Course: Integrated Therapeutics 1 Lecturer: Dr. E. Konorev Date: November 27, 2012 Materials on: Exam #5 Required reading: Katzung, Chapter 14 1 CARDIAC ARRHYTHMIAS Abnormalities

More information

Mr. Eknath Kole M.S. Pharm (NIPER Mohali)

Mr. Eknath Kole M.S. Pharm (NIPER Mohali) M.S. Pharm (NIPER Mohali) Drug Class Actions Therapeutic Uses Pharmacokinetics Adverse Effects Other Quinidine IA -Binds to open and inactivated Na+ -Decreases the slope of Phase 4 spontaneous depolarization

More information

Arrhythmias. Simple-dysfunction cause abnormalities in impulse formation and conduction in the myocardium.

Arrhythmias. Simple-dysfunction cause abnormalities in impulse formation and conduction in the myocardium. Arrhythmias Simple-dysfunction cause abnormalities in impulse formation and conduction in the myocardium. However, in clinic it present as a complex family of disorders that show variety of symptoms, for

More information

Arrhythmias. 1. beat too slowly (sinus bradycardia). Like in heart block

Arrhythmias. 1. beat too slowly (sinus bradycardia). Like in heart block Arrhythmias It is a simple-dysfunction caused by abnormalities in impulse formation and conduction in the myocardium. The heart is designed in such a way that allows it to generate from the SA node electrical

More information

Drugs Controlling Myocyte Excitability and Conduction at the AV node Singh and Vaughan-Williams Classification

Drugs Controlling Myocyte Excitability and Conduction at the AV node Singh and Vaughan-Williams Classification Drugs Controlling Myocyte Excitability and Conduction at the AV node Singh and Vaughan-Williams Classification Class I Na Channel Blockers Flecainide Propafenone Class III K channel Blockers Dofetilide,

More information

Chapter 14. Agents used in Cardiac Arrhythmias

Chapter 14. Agents used in Cardiac Arrhythmias Chapter 14 Agents used in Cardiac Arrhythmias Cardiac arrhythmia Approximately 50% of post-myocardial infarction fatalities result from ventricular tachycarida (VT) or ventricular fibrillation (VF). These

More information

ANTI - ARRHYTHMIC DRUGS

ANTI - ARRHYTHMIC DRUGS ANTI - ARRHYTHMIC DRUGS CARDIAC ACTION POTENTIAL K Out Balance Ca in/k out Na in K Out GENERATION OF ARRHYTHMIAS Four mechanisms of arrhythmia generation; Increased normal automaticity Abnormal automaticity

More information

Rhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014

Rhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014 Rhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014 Financial disclosures Consultant Medtronic 3 reasons to evaluate and treat arrhythmias

More information

Dronedarone in the Post-Pallas Era. Jorge E. Schliamser, MD Carmel Medical Center Haifa

Dronedarone in the Post-Pallas Era. Jorge E. Schliamser, MD Carmel Medical Center Haifa Dronedarone in the Post-Pallas Era Jorge E. Schliamser, MD Carmel Medical Center Haifa Disclosures None Dronedarone is a multichannel blocker Dronedarone possesses electrophysiologic characteristics of

More information

Chapter 9. Learning Objectives. Learning Objectives 9/11/2012. Cardiac Arrhythmias. Define electrical therapy

Chapter 9. Learning Objectives. Learning Objectives 9/11/2012. Cardiac Arrhythmias. Define electrical therapy Chapter 9 Cardiac Arrhythmias Learning Objectives Define electrical therapy Explain why electrical therapy is preferred initial therapy over drug administration for cardiac arrest and some arrhythmias

More information

Atrial Fibrillation 2009

Atrial Fibrillation 2009 Atrial Fibrillation 2009 Michael Glikson, MD Director of Pacing & Electrophysiology Leviev Heart Center Sheba medical Center Sheba Medical Center Tel Hashomer The Leviev Heart Center Rhythm vs rate control

More information

Antiarrhythmic Drugs 1/31/2018 1

Antiarrhythmic Drugs 1/31/2018 1 Antiarrhythmic Drugs 1/31/2018 1 Normal conduction pathway: 1- SA node generates action potential and delivers it to the atria and the AV node 2- The AV node delivers the impulse to purkinje fibers Other

More information

The most common. hospitalized patients. hypotension due to. filling time Rate control in ICU patients may be difficult as many drugs cause hypotension

The most common. hospitalized patients. hypotension due to. filling time Rate control in ICU patients may be difficult as many drugs cause hypotension Arrhythmias in the critically ill ICU patients: Approach for rapid recognition & management Objectives Be able to identify and manage: Atrial fibrillation with a rapid ventricular response Atrial flutter

More information

Pediatrics ECG Monitoring. Pediatric Intensive Care Unit Emergency Division

Pediatrics ECG Monitoring. Pediatric Intensive Care Unit Emergency Division Pediatrics ECG Monitoring Pediatric Intensive Care Unit Emergency Division 1 Conditions Leading to Pediatric Cardiology Consultation 12.7% of annual consultation Is arrhythmias problems Geggel. Pediatrics.

More information

Medical management of AF: drugs for rate and rhythm control

Medical management of AF: drugs for rate and rhythm control Medical management of AF: drugs for rate and rhythm control Adel Khalifa Sultan Hamad, BMS, MD, FGHRS, FRCP(Canada) Consultant Cardiologist & Interventional Cardiac Electrophysiologist Head of Electrophysiology

More information

Antiarrhythmic Drugs. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018

Antiarrhythmic Drugs. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 Antiarrhythmic Drugs Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 2 Ion Permeability Changes Potential Changes Genes and Proteins 3 Cardiac Na+ channels 5 6

More information

Use of Antiarrhythmic Drugs for AF Who, What and How? Dr. Marc Cheng Queen Elizabeth Hospital

Use of Antiarrhythmic Drugs for AF Who, What and How? Dr. Marc Cheng Queen Elizabeth Hospital Use of Antiarrhythmic Drugs for AF Who, What and How? Dr. Marc Cheng Queen Elizabeth Hospital Content i. Rhythm versus Rate control ii. Anti-arrhythmic for Rhythm Control iii. Anti-arrhythmic for Rate

More information

Antiarrhythmic Drugs. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2017

Antiarrhythmic Drugs. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2017 Antiarrhythmic Drugs Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2017 Types of Cardiac Arrhythmias Abnormalities of Impulse Formation: Rate disturbances. Triggered

More information

! YOU NEED TO MONITOR QT INTERVALS IN THESE PATIENTS.

! YOU NEED TO MONITOR QT INTERVALS IN THESE PATIENTS. Antiarrhythmic Pharmacopoeia Powerful drugs, split into 4 major classes, according to the predominant receptor they effect. Some fit into several classes at once, like sotolol. Some don t fit at all, owing

More information

ANTI-ARRHYTHMICS AND WARFARIN. Dr Nithish Jayakumar

ANTI-ARRHYTHMICS AND WARFARIN. Dr Nithish Jayakumar ANTI-ARRHYTHMICS AND WARFARIN Dr Nithish Jayakumar Contents 1. Anti-arrhythmics Pacemaker and myocardial potentials Drug classes mechanisms; s/e; contra-indications Management of common arrhythmias 2.

More information

B. 14 Antidysrhythmic drugs. a. Classify antidysrhythmics by their electrophysiological actions. Vaughan-Williams classification

B. 14 Antidysrhythmic drugs. a. Classify antidysrhythmics by their electrophysiological actions. Vaughan-Williams classification B. 14 Antidysrhythmic drugs a. Classify antidysrhythmics by their electrophysiological actions. Vaughan-Williams classification I II III IV membrane stabilizers all ERP, ERP/APD, all except c APD classified

More information

Basic Electrophysiology

Basic Electrophysiology Basic Electrophysiology Michael Eldar, M.D. Heart Institute Sheba Medical Center Caesaria 2010 Transmembrane Ion-Transfer Modes Ion Channel Pump Exchanger Opie LH, The Heart 1998:75 Voltage-Gated Sodium

More information

Atrial Fibrillation 10/2/2018. Depolarization & ECG. Atrial Fibrillation. Hemodynamic Consequences

Atrial Fibrillation 10/2/2018. Depolarization & ECG. Atrial Fibrillation. Hemodynamic Consequences Depolarization & ECG Atrial Fibrillation How to make ORDER out of CHAOS Julia Shih, VMD, DACVIM (Cardiology) October 27, 2018 Depolarization & ECG Depolarization & ECG Atrial Fibrillation Hemodynamic Consequences

More information

ΚΟΛΠΙΚΗ ΜΑΡΜΑΡΥΓΗ ΦΑΡΜΑΚΕΥΤΙΚΗ ΗΛΕΚΤΡΙΚΗ ΑΝΑΤΑΞΗ. ΣΠΥΡΟΜΗΤΡΟΣ ΓΕΩΡΓΙΟΣ Καρδιολόγος, Ε/Α, Γ.Ν.Κατερίνης. F.E.S.C

ΚΟΛΠΙΚΗ ΜΑΡΜΑΡΥΓΗ ΦΑΡΜΑΚΕΥΤΙΚΗ ΗΛΕΚΤΡΙΚΗ ΑΝΑΤΑΞΗ. ΣΠΥΡΟΜΗΤΡΟΣ ΓΕΩΡΓΙΟΣ Καρδιολόγος, Ε/Α, Γ.Ν.Κατερίνης. F.E.S.C ΚΟΛΠΙΚΗ ΜΑΡΜΑΡΥΓΗ ΦΑΡΜΑΚΕΥΤΙΚΗ ΗΛΕΚΤΡΙΚΗ ΑΝΑΤΑΞΗ ΣΠΥΡΟΜΗΤΡΟΣ ΓΕΩΡΓΙΟΣ Καρδιολόγος, Ε/Α, Γ.Ν.Κατερίνης. F.E.S.C Definitions of AF: A Simplified Scheme Term Definition Paroxysmal AF AF that terminates

More information

Antiarrhythmic Drugs Öner Süzer

Antiarrhythmic Drugs Öner Süzer Antiarrhythmic Drugs Öner Süzer www.onersuzer.com osuzer@istanbul.edu.tr Last update: 09.11.2009 1 Süzer Farmakoloji 3. Baskı 2005 2 1 Süzer Farmakoloji 3. Baskı 2005 3 Figure 14 1 Schematic representation

More information

Antiarrhythmic Pharmacology. The Electronics

Antiarrhythmic Pharmacology. The Electronics Antiarrhythmic Pharmacology Linking Pharmacological Treatment to the Patient and the Rhythm Presented By: Karen Marzlin BSN, RN,C, CCRN-CMC CNEA 2009 1 The Electronics Action Potential of Cardiac Cells

More information

I have nothing to disclose.

I have nothing to disclose. I have nothing to disclose. Antiarrhythmic Therapy in Pregnancy Prof. Ali Oto,MD,FESC,FACC,FHRS Department of Cardiology Hacettepe University,Faculty of Medicine Ankara Arrhythmias in pregnancy An increased

More information

Rate and Rhythm Control of Atrial Fibrillation

Rate and Rhythm Control of Atrial Fibrillation Rate and Rhythm Control of Atrial Fibrillation April 21, 2017 춘계심혈관통합학술대회 Jaemin Shim, MD, PhD Arrhythmia Center Korea University Anam Hospital Treatment of AF Goal Reducing symptoms Preventing complication

More information

How do arrhythmias occur?

How do arrhythmias occur? How do arrhythmias occur? An arrhythmia is an abnormal heart rhythm (= dysrhythmia). Can be fast (tachy) or slow (brady). Brady arrhythmias are usually due to conduc;on block, while tachyarrhythmias are

More information

Pharmacology: Arrhythmias PC PHPP 515 (IT I) Fall JACOBS Wed, Dec. 03 4:00 5:50 PM

Pharmacology: Arrhythmias PC PHPP 515 (IT I) Fall JACOBS Wed, Dec. 03 4:00 5:50 PM Pharmacology: Arrhythmias PC PHPP 515 (IT I) Fall 2014 JACOBS Wed, Dec. 03 4:00 5:50 PM Required Reading (via Access Pharmacy) Katzung: Chapters 14 Recommended Reading (via Access Pharmacy) Goodman and

More information

Atrial Fibrillation and Common Supraventricular Tachycardias. Sunil Kapur MD

Atrial Fibrillation and Common Supraventricular Tachycardias. Sunil Kapur MD Atrial Fibrillation and Common Supraventricular Tachycardias Sunil Kapur MD Cardiac Electrophysiology Brigham and Women s Hospital Instructor, Harvard Medical School No disclosures Cardiac Conduction:

More information

ELECTRICAL SIGNALS CONTROL THE CARDIAC ACTIVITY

ELECTRICAL SIGNALS CONTROL THE CARDIAC ACTIVITY ELECTRICAL SIGNALS CONTROL THE CARDIAC ACTIVITY The heart beat begins when an electrical impulse from the sinoatrial node (SA node or sinus node) moves through it. The normal electrical sequence begins

More information

Are Drugs Better? Dr Mauro Lencioni. Drugs or ablation as first line treatment for AF? Consultant Cardiologist & Electrophysiologist

Are Drugs Better? Dr Mauro Lencioni. Drugs or ablation as first line treatment for AF? Consultant Cardiologist & Electrophysiologist Are Drugs Better? Drugs or ablation as first line treatment for AF? Dr Mauro Lencioni Consultant Cardiologist & Electrophysiologist The Philosophical Issue What do we mean by Better? Outcome measures Measurement

More information

ARRHYTHMIAS IN THE ICU

ARRHYTHMIAS IN THE ICU ARRHYTHMIAS IN THE ICU Nora Goldschlager, MD MACP, FACC, FAHA, FHRS SFGH Division of Cardiology UCSF IDENTIFIED VARIABLES IN ARRHYTHMOGENESIS Ischemia/infarction (scar) Electrolyte imbalance Proarrhythmia

More information

Targeting the late sodium channel: A new antiarrhythmic paradigm?

Targeting the late sodium channel: A new antiarrhythmic paradigm? Targeting the late sodium channel: A new antiarrhythmic paradigm? Wojciech Zareba, MD, PhD Professor of Medicine/Cardiology University of Rochester Medical Center Rochester, NY Disclosures: - Gilead Sciences:

More information

DECLARATION OF CONFLICT OF INTEREST. Consultant Sanofi Biosense Webster Honorarium Boehringer Ingelheim St Jude Medical

DECLARATION OF CONFLICT OF INTEREST. Consultant Sanofi Biosense Webster Honorarium Boehringer Ingelheim St Jude Medical DECLARATION OF CONFLICT OF INTEREST Consultant Sanofi Biosense Webster Honorarium Boehringer Ingelheim St Jude Medical ESC Congress Paris, France August 27-31, 2011 Risk & Complications of AADs for Rhythm

More information

» A new drug s trial

» A new drug s trial » A new drug s trial A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause

More information

Basic Electrophysiology

Basic Electrophysiology Basic Electrophysiology Michael Eldar, M.D. Heart Institute Sheba Medical Center Caesaria 2008 ? מי מהבאים יוצא דופן.1 Ica Ik Ryanodin receptor Na/K ATPase pump Ca/Na exchanger ' התשובה ג THE HEART INSTITUTE

More information

Introduction. Circulation

Introduction. Circulation Introduction Circulation 1- Systemic (general) circulation 2- Pulmonary circulation carries oxygenated blood to all parts of the body carries deoxygenated blood to the lungs From Lt. ventricle aorta From

More information

Cardiac Properties MCQ

Cardiac Properties MCQ Cardiac Properties MCQ Abdel Moniem Ibrahim Ahmed, MD Professor of Cardiovascular Physiology Cairo University 2007 1- Cardiac Valves: a- Prevent backflow of blood from the ventricles to the atria during

More information

The action potential and the underlying ionic currents. Norbert Jost, PhD

The action potential and the underlying ionic currents. Norbert Jost, PhD The action potential and the underlying ionic currents Norbert Jost, PhD The propagation of the stimulation in the heart Sinus node Left atria His Bundle Conduction velocity in m/s Time to arrive from

More information

Cardiac Arrhythmias. For Pharmacists

Cardiac Arrhythmias. For Pharmacists Cardiac Arrhythmias For Pharmacists Agenda Overview of the normal Classification Management Therapy Conclusion Cardiac arrhythmias Overview of the normal Arrhythmia: definition From the Greek a-, loss

More information

SHOCK THE PATIENT. Disclosures. Goals of the Talk. Tachyarrhythmias- Unstable 11/7/2017

SHOCK THE PATIENT. Disclosures. Goals of the Talk. Tachyarrhythmias- Unstable 11/7/2017 Disclosures Common Heart Rhythms in the Hospital Research Support: NIH, PCORI, Medtronic, Cardiogram Consulting: InCarda, Johnson & Johnson, Lifewatch Equity: InCarda Gregory M Marcus, MD, MAS Associate

More information

Saudi Heart Association February 22, 2011

Saudi Heart Association February 22, 2011 Pharmacological Therapy of Atrial Fibrillation: Recent Advances Dr Martin Green Professor of Medicine (Cardiology) University of Ottawa Saudi Heart Association February 22, 2011 Atrial Fibrillation Drugs

More information

Basic Electrophysiology. Transmembrane Ion-Transfer Modes

Basic Electrophysiology. Transmembrane Ion-Transfer Modes 1. מי מהבאים יוצא דופן? א- I ca ב- I k ג- Ryanodin receptor ד- Na/K ATPase pump ה- Ca/Na exchanger Basic Electrophysiology Michael Eldar Heart Institute Sheba Medical Center Ceasaria, 2004 התשובה ג' Transmembrane

More information

Antidysrhythmics HST-151 1

Antidysrhythmics HST-151 1 HST-151 1 Antidysrhythmics I. Ventricular muscle cell action potential a. Phase 0: Upstroke b. Phase 1: Early-fast repolarization c. Phase 2: Plateau d. Phase 3: Repolarization e. Phase 4: Diastole HST-151

More information

There are future perspectives in the pharmacological treatment of arrhythmias

There are future perspectives in the pharmacological treatment of arrhythmias There are future perspectives in the pharmacological treatment of arrhythmias George Andrikopoulos, MD, PhD, FESC, Cardiologist, Director, 1st Department of Cardiology/ Department of Electrophysiology

More information

Differences in cardiac atrial and ventricular ion channels

Differences in cardiac atrial and ventricular ion channels Differences in cardiac atrial and ventricular ion channels Norbert Jost, PhD Department of Pharmacology & Pharmacotherapy, University of Szeged Division for Cardiovascular Pharmacology, Hungarian Academy

More information

The pill-in-the-pocket strategy for paroxysmal atrial fibrillation

The pill-in-the-pocket strategy for paroxysmal atrial fibrillation The pill-in-the-pocket strategy for paroxysmal atrial fibrillation KONSTANTINOS P. LETSAS, MD, FEHRA LABORATORY OF CARDIAC ELECTROPHYSIOLOGY EVANGELISMOS GENERAL HOSPITAL OF ATHENS ARRHYTHMIAS UPDATE,

More information

Dysrhythmias. Dysrythmias & Anti-Dysrhythmics. EKG Parameters. Dysrhythmias. Components of an ECG Wave. Dysrhythmias

Dysrhythmias. Dysrythmias & Anti-Dysrhythmics. EKG Parameters. Dysrhythmias. Components of an ECG Wave. Dysrhythmias Dysrhythmias Dysrythmias & Anti-Dysrhythmics Rhythm bad in the heart: Whitewater rafting Electrical impulses coordinate heart Reduction in Cardiac Output PEA Asystole Components of an ECG Wave EKG Parameters

More information

Alaska Nurse Practitioner Annual Conference 2009

Alaska Nurse Practitioner Annual Conference 2009 Alaska Nurse Practitioner Annual Conference 2009 LAURIE RACENET, RN, MSN, ANP, CEPS, CCDS Alaska Heart Institute Member: Boston Scientific Allied Professional Advisory Board Participant in Industry Sponsored

More information

Chapter (9) Calcium Antagonists

Chapter (9) Calcium Antagonists Chapter (9) Calcium Antagonists (CALCIUM CHANNEL BLOCKERS) Classification Mechanism of Anti-ischemic Actions Indications Drug Interaction with Verapamil Contraindications Adverse Effects Treatment of Drug

More information

ARRHYTHMIA SINUS RHYTHM

ARRHYTHMIA SINUS RHYTHM ARRHYTHMIA Dr. Ahmed A. Elberry, MBBCH, MSc, MD Assistant Professor of Clinical Pharmacy Faculty of pharmacy, KAU 1 SINUS RHYTHM SA node is cardiac pacemaker Normal sinus rhythm 60-100 beats/min Depolarisation

More information

Antiarrhythmic Drugs Öner Süzer

Antiarrhythmic Drugs Öner Süzer Antiarrhythmic Drugs Öner Süzer www.onersuzer.com osuzer@istanbul.edu.tr Last update: 13.01.2009 1 Süzer Farmakoloji 3. Baskı 2005 2 1 Süzer Farmakoloji 3. Baskı 2005 3 Figure 14 1 Schematic representation

More information

Chapter 26. Media Directory. Dysrhythmias. Diagnosis/Treatment of Dysrhythmias. Frequency in Population Difficult to Predict

Chapter 26. Media Directory. Dysrhythmias. Diagnosis/Treatment of Dysrhythmias. Frequency in Population Difficult to Predict Chapter 26 Drugs for Dysrythmias Slide 33 Slide 35 Media Directory Propranolol Animation Amiodarone Animation Upper Saddle River, New Jersey 07458 All rights reserved. Dysrhythmias Abnormalities of electrical

More information

AF#in#pa(ents#with#CAD# Is#dronedarone#a#good#choice?!

AF#in#pa(ents#with#CAD# Is#dronedarone#a#good#choice?! AF#in#pa(ents#with#CAD# Is#dronedarone#a#good#choice?! DRUG#PROPHYLAXIS#OF#AF:# FOCUS#ON#DRONEDARONE# Friday#16C10C2015# Harry%JGM%Crijns% Maastricht,%The%Netherlands% Disclosures Harry Crijns - research

More information

Ablation Update and Case Studies. Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group

Ablation Update and Case Studies. Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group Ablation Update and Case Studies Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group Disclosures No financial relationships to disclose Objectives At the conclusion of this activity,

More information

Amiodarone Prescribing and Monitoring: Back to the Future

Amiodarone Prescribing and Monitoring: Back to the Future Amiodarone Prescribing and Monitoring: Back to the Future Subha L. Varahan, MD, FHRS, CCDS Electrophysiologist Oklahoma Heart Hospital Oklahoma City, OK Friday, February, 8 th, 2019 Iodinated benzofuran

More information

Treatment of Arrhythmias in the Emergency Setting

Treatment of Arrhythmias in the Emergency Setting Treatment of Arrhythmias in the Emergency Setting Zian H. Tseng, M.D. Assistant Professor of Medicine Cardiac Electrophysiology Section Cardiology Division University of California, San Francisco There

More information

Where are the normal pacemaker and the backup pacemakers of the heart located?

Where are the normal pacemaker and the backup pacemakers of the heart located? CASE 9 A 68-year-old woman presents to the emergency center with shortness of breath, light-headedness, and chest pain described as being like an elephant sitting on her chest. She is diagnosed with a

More information

Acute Arrhythmias in the Hospitalized Patient

Acute Arrhythmias in the Hospitalized Patient Acute Arrhythmias in the Hospitalized Patient Gregory M Marcus, MD, MAS Associate Professor of Medicine Division of Cardiology University of California, San Francisc Disclosures Medtronic: Research Support

More information

Polypharmacy - arrhythmic risks in patients with heart failure

Polypharmacy - arrhythmic risks in patients with heart failure Influencing sudden cardiac death by pharmacotherapy Polypharmacy - arrhythmic risks in patients with heart failure Professor Dan Atar Head, Dept. of Cardiology Oslo University Hospital Ullevål Norway 27.8.2012

More information

This document does not consider management of individual arrhythmias look elsewhere, e.g. OHCM.

This document does not consider management of individual arrhythmias look elsewhere, e.g. OHCM. Cardiac arrhythmias This document does not consider management of individual arrhythmias look elsewhere, e.g. OHCM. Physiology Automaticity = ability of specialised cardiac conducting tissue to spontaneously

More information

Chapter 16: Arrhythmias and Conduction Disturbances

Chapter 16: Arrhythmias and Conduction Disturbances Complete the following. Chapter 16: Arrhythmias and Conduction Disturbances 1. Cardiac arrhythmias result from abnormal impulse, abnormal impulse, or both mechanisms together. 2. is the ability of certain

More information

Atrial Fibrillation: Rate vs. Rhythm. Michael Curley, MD Cardiac Electrophysiology

Atrial Fibrillation: Rate vs. Rhythm. Michael Curley, MD Cardiac Electrophysiology Atrial Fibrillation: Rate vs. Rhythm Michael Curley, MD Cardiac Electrophysiology I have no relevant financial disclosures pertaining to this topic. A Fib Epidemiology #1 Most common heart rhythm disturbance

More information

Heart Failure (HF) Treatment

Heart Failure (HF) Treatment Heart Failure (HF) Treatment Heart Failure (HF) Complex, progressive disorder. The heart is unable to pump sufficient blood to meet the needs of the body. Its cardinal symptoms are dyspnea, fatigue, and

More information

New Agents for Heart Failure: Ivabradine Jeffrey S. Borer, MD

New Agents for Heart Failure: Ivabradine Jeffrey S. Borer, MD New Agents for Heart Failure: Ivabradine Jeffrey S. Borer, MD Professor of Medicine, Cell Biology, Radiology and Surgery Director, The Howard Gilman Institute for Heart Valve Disease and the Schiavone

More information

ARRHYTHMIAS IN THE ICU: DIAGNOSIS AND PRINCIPLES OF MANAGEMENT

ARRHYTHMIAS IN THE ICU: DIAGNOSIS AND PRINCIPLES OF MANAGEMENT ARRHYTHMIAS IN THE ICU: DIAGNOSIS AND PRINCIPLES OF MANAGEMENT Nora Goldschlager, M.D. MACP, FACC, FAHA, FHRS SFGH Division of Cardiogy UCSF CLINICAL VARIABLES IN ARRHYTHMOGENESIS Ischemia/infarction (scar)

More information

CVD: Cardiac Arrhythmias. 1. Final Cardiac Arrhythmias_BMP. 1.1 Cardiovascular Disease. Notes:

CVD: Cardiac Arrhythmias. 1. Final Cardiac Arrhythmias_BMP. 1.1 Cardiovascular Disease. Notes: CVD: Cardiac Arrhythmias 1. Final Cardiac Arrhythmias_BMP 1.1 Cardiovascular Disease 1.2 Directions for taking this course 1.3 Content Experts 1.4 Disclosures 1.5 Accreditation Information 1.6 Learning

More information

Arrhythmias (I) Supraventricular Tachycardias. Disclosures

Arrhythmias (I) Supraventricular Tachycardias. Disclosures Arrhythmias (I) Supraventricular Tachycardias Amy Leigh Miller, MD, PhD Cardiovascular Electrophysiology, Brigham & Women s Hospital Disclosures None Short R-P Tachycardia REGULAR with 1:1 P/R relationship

More information

1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material

1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material 1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material Arrhythmia recognition This tutorial builds on the ECG lecture and provides a framework for approaching any ECG to allow the

More information

Anti arrhythmic drugs. Hilal Al Saffar College of medicine Baghdad University

Anti arrhythmic drugs. Hilal Al Saffar College of medicine Baghdad University Anti arrhythmic drugs Hilal Al Saffar College of medicine Baghdad University Mechanism of Arrhythmia Abnormal heart pulse formation Abnormal heart pulse conduction Classification of Arrhythmia Abnormal

More information

APPROACH TO TACHYARRYTHMIAS

APPROACH TO TACHYARRYTHMIAS APPROACH TO TACHYARRYTHMIAS PROF.DR.MD.ZAKIR HOSSAIN PROFESSOR AND HEAD DEPARTMENT OF MEDICINE SZMCH TACHYARRYTHMIA Cardiac arrythmia is a disturbance of electrical rhythm of heart. Cardac arrythmia with

More information

Etienne Aliot. University of Nancy - France

Etienne Aliot. University of Nancy - France Etienne Aliot University of Nancy - France Disclosures Consulting fees : - Bayer, Boehringer Ingelheim,GSK, MedaPharma, Pfizer/BMS,Sanofi Aventis. - Biotronik,Medtronic,St Jude Medical. Electrical vs Pharmacological

More information

Dysrhythmias 11/7/2017. Disclosures. 3 reasons to evaluate and treat dysrhythmias. None. Eliminate symptoms and improve hemodynamics

Dysrhythmias 11/7/2017. Disclosures. 3 reasons to evaluate and treat dysrhythmias. None. Eliminate symptoms and improve hemodynamics Dysrhythmias CYDNEY STEWART MD, FACC NOVEMBER 3, 2017 Disclosures None 3 reasons to evaluate and treat dysrhythmias Eliminate symptoms and improve hemodynamics Prevent imminent death/hemodynamic compromise

More information

Atrial fibrillation in the ICU

Atrial fibrillation in the ICU Atrial fibrillation in the ICU Atrial fibrillation Preexisting or incident (new onset) among nearly one in three critically ill patients Formation of arrhythogenic substrate usually fibrosis (CHF, hypertension,

More information

ABLATION OF CHRONIC AF

ABLATION OF CHRONIC AF ABLATION OF CHRONIC AF A PISAPIA ST JOSEPH HOSPITAL MARSEILLE MEET 2008 Atrial Fibrillation The most common significant heart rhythm disturbance Incidence increases with age and the development of structural

More information

ΝΕΟΤΕΡΑ ΚΑΙ ΜΕΛΛΟΝΤΙΚΑ ΑΝΤΙΑΡΡΥΘΜΙΚΑ ΦΑΡΜΑΚΑ (ΑΑΦ-AAD)

ΝΕΟΤΕΡΑ ΚΑΙ ΜΕΛΛΟΝΤΙΚΑ ΑΝΤΙΑΡΡΥΘΜΙΚΑ ΦΑΡΜΑΚΑ (ΑΑΦ-AAD) ΝΕΟΤΕΡΑ ΚΑΙ ΜΕΛΛΟΝΤΙΚΑ ΑΝΤΙΑΡΡΥΘΜΙΚΑ ΦΑΡΜΑΚΑ (ΑΑΦ-AAD) ΣΤΕΛΙΟΣ ΠΑΡΑΣΚΕΥΑÏΔΗΣ ΔΙΕΥΘΥΝΤΗΣ ΕΣΥ Α Καρδιολογική Κλινική ΑΠΘ, Νοσοκομείο ΑΧΕΠΑ, Θεσσαλονίκη NO CONFLICT OF INTEREST 1985 selectivity and effectiveness

More information

Φαρμακεσηική αγωγή ζηις ιδιοπαθείς κοιλιακές αρρσθμίες. Άννα Κωζηοπούλοσ Επιμελήηρια Α Ωνάζειο Καρδιοτειροσργικό Κένηρο

Φαρμακεσηική αγωγή ζηις ιδιοπαθείς κοιλιακές αρρσθμίες. Άννα Κωζηοπούλοσ Επιμελήηρια Α Ωνάζειο Καρδιοτειροσργικό Κένηρο Φαρμακεσηική αγωγή ζηις ιδιοπαθείς κοιλιακές αρρσθμίες Άννα Κωζηοπούλοσ Επιμελήηρια Α Ωνάζειο Καρδιοτειροσργικό Κένηρο Όλες οι κοιλιακές αρρσθμίες δεν είναι ίδιες Υπάρτοσν διαθορές ζηον πληθυσμό, ηον μηχανισμό

More information

Debate PRO. Dronedarone is an important drug in the management of paroxysmal atrial fibrillation. John Camm

Debate PRO. Dronedarone is an important drug in the management of paroxysmal atrial fibrillation. John Camm ESC ICM - Internationales Congress Center München 2012 Atrial Fibrillation Controversies in Medical Treatment Debate Dronedarone is an important drug in the management of paroxysmal atrial fibrillation

More information

Management of acute Cardiac Arrhythmias

Management of acute Cardiac Arrhythmias Management of acute Cardiac Arrhythmias Dr. Zulkeflee Muhammad MBChB (New Zealand), MRCP (United Kingdom) Cardiologist Electrophysiology Unit Istitut Jantung Negara Objectives Review the etiology and recognition

More information

Antiarrhythmics 17 I. OVERVIEW II. INTRODUCTION TO THE ARRHYTHMIAS

Antiarrhythmics 17 I. OVERVIEW II. INTRODUCTION TO THE ARRHYTHMIAS Antiarrhythmics 17 I. OVERVIEW In contrast to skeletal muscle, which contracts only when it receives a stimulus, the heart contains specialized cells that exhibit automaticity. This means that they can

More information

Safety and Efficacy of Dronedarone in the Treatment of Atrial Fibrillation/Flutter

Safety and Efficacy of Dronedarone in the Treatment of Atrial Fibrillation/Flutter Clinical Medicine Insights: Cardiology Expert Review Open Access Full open access to this and thousands of other papers at http://www.la-press.com. Safety and Efficacy of Dronedarone in the Treatment of

More information

Atrial repolarizing delaying agents (Vernakalant, Xention)

Atrial repolarizing delaying agents (Vernakalant, Xention) Atrial repolarizing delaying agents (Vernakalant, Xention) Juan Tamargo, MD, PhD, FESC DISCLOSURES Consulting fees: Sanofi-Aventis, Menarini Department of Pharmacology, School of Medicine Universidad Complutense,

More information

Antiarrhythmias. Edward JN Ishac, Ph.D. Smith Building, Room

Antiarrhythmias. Edward JN Ishac, Ph.D. Smith Building, Room Antiarrhythmias Edward JN Ishac, Ph.D. Smith Building, Room 72 eishac@vcu.edu 828-2127 Department of Pharmacology and Toxicology Medical College of Virginia Campus of Virginia Commonwealth University Richmond,

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line Treatment of Paroxysmal Atrial Fibrillation (RAAFT-2): a randomzied clinical

More information

Update on Dronedarone and Cardiovascular Outcomes

Update on Dronedarone and Cardiovascular Outcomes Update on and Cardiovascular Outcomes Dr. Stuart Connolly MD McMaster University Hamilton Ontario Disclosure: Research grants, speaker fees and consulting honoraria from sanofi aventis has key structural

More information

Pharmacotherapy of Antiarrhythmias

Pharmacotherapy of Antiarrhythmias Pharmacotherapy of Antiarrhythmias Edward JN Ishac, Ph.D. Smith Building, Room 72 eishac@vcu.edu 828-2127 Department of Pharmacology and Toxicology Medical College of Virginia Campus of Virginia Commonwealth

More information

Gene annotation for heart rhythm. 1. Control of heart rate 2. Action Potential 3. Ion channels and transporters 4. Arrhythmia 5.

Gene annotation for heart rhythm. 1. Control of heart rate 2. Action Potential 3. Ion channels and transporters 4. Arrhythmia 5. Gene annotation for heart rhythm 1. Control of heart rate 2. Action Potential 3. Ion channels and transporters 4. Arrhythmia 5. EC coupling Control of heart rate Autonomic regulation of heart function

More information

Comparison of different proarrhythmia biomarkers in isolated rabbit hearts

Comparison of different proarrhythmia biomarkers in isolated rabbit hearts Comparison of different proarrhythmia biomarkers in isolated rabbit hearts Summary of PhD Thesis Szabolcs Orosz, MSc Supervisor: Attila Farkas MD, PhD 2nd Dept. of Internal Medicine and Cardiology Centre

More information

ECGs and Arrhythmias: Family Medicine Board Review 2009

ECGs and Arrhythmias: Family Medicine Board Review 2009 Rate Rhythm Intervals Hypertrophy ECGs and Arrhythmias: Family Medicine Board Review 2009 Axis Jess (Fogler) Waldura, MD University of California, San Francisco walduraj@nccc.ucsf.edu Ischemia Overview

More information

Current Guideline for AF Treatment. Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine

Current Guideline for AF Treatment. Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine Current Guideline for AF Treatment Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine Case 1 59 year-old lady Sudden palpitation and breathlessness for 12 hours

More information

Short QT Syndrome: Pharmacological Treatment

Short QT Syndrome: Pharmacological Treatment Journal of the American College of Cardiology Vol. 43, No. 8, 2004 2004 by the American College of Cardiology Foundation ISSN 0735-1097/04/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2004.02.034

More information

What s new in my specialty?

What s new in my specialty? What s new in my specialty? Jon Melman, MD Heart Rhythm Specialists McKay-Dee Hospital some would say some would say my specialty 1 some would say my specialty First pacemaker 1958 some would say my specialty

More information

Antiarrhythmic Pharmacology: Important Practice Implications

Antiarrhythmic Pharmacology: Important Practice Implications Antiarrhythmic Pharmacology: Important Practice Implications NTI 2015 San Diego Session A75M457 Presented By: Karen Marzlin DNP, RN, CCNS, CCRN-CMC, CHFN 1 Methodology Rhythm Interpretation Patient Information

More information

Core Content In Urgent Care Medicine

Core Content In Urgent Care Medicine Palpitations/Arrhythmias Ebrahim Barkoudah, MD Clinical Instructor in Internal Medicine Harvard Medical School Assistant in Internal Medicine & Pediatrics Massachusetts General Hospital MGH Chelsea Chelsea,

More information

TdP Mechanisms and CiPA

TdP Mechanisms and CiPA TdP Mechanisms and CiPA Craig T. January, MD, PhD Division of Cardiovascular Medicine University of Wisconsin-Madison Cardiac Safety Research Consortium Hilton Washington DC December 6, 2016 Disclosures

More information

Drugs in Cardiology. Fozia Ahmed. Consultant Cardiologist Manchester Heart Centre

Drugs in Cardiology. Fozia Ahmed. Consultant Cardiologist Manchester Heart Centre Drugs in Cardiology Fozia Ahmed Consultant Cardiologist Manchester Heart Centre What do you need to know about pharmacology for BHRS exam Cardiac action potential Vaughn William s classification Effects

More information

National Horizon Scanning Centre. Dronedarone (Multaq) for atrial fibrillation and atrial flutter. December 2007

National Horizon Scanning Centre. Dronedarone (Multaq) for atrial fibrillation and atrial flutter. December 2007 Dronedarone (Multaq) for atrial fibrillation and atrial flutter December 2007 This technology summary is based on information available at the time of research and a limited literature search. It is not

More information