- Foreword
- Preface
- Acknowledgements
- Contributors
- List of abbreviations
- Part I Coronary heart disease
- Chapter 1 Epidemiology, outcomes, and quality of care
- Chapter 2 Lipids and cardiovascular disease
- Chapter 3 Myocardial ischaemia
- Chapter 4 Thrombosis, haemostasis, and platelet biology
- Chapter 5 Medical versus invasive management of coronary heart disease
- Chapter 6 Percutaneous coronary intervention
- Chapter 7 Percutaneous coronary intervention versus coronary artery bypass graft surgery
- Part II Cardiac electrophysiology and heart rhythm disturbances
- Chapter 8 Epidemiology and molecular foundation
- Chapter 9 Atrial fibrillation
- Chapter 10 Interventional electrophysiology
- Chapter 11 Anti-arrhythmic drug therapy
- Part III Heart failure
- Chapter 12 Epidemiology
- Chapter 13 Medical management
- Chapter 14 Cardiac resynchronization therapy
- Chapter 15 Non-ischaemic cardiomyopathy
- Chapter 16 Cardiac failure and transplantation
- Part IV Hypertension
- Chapter 17 Systemic arterial hypertension
- Chapter 18 Pulmonary arterial hypertension
- Part V Valvular heart disease
- Chapter 19 Epidemiology and intervention
- Chapter 20 Endocarditis
- Part VI Cardiac imaging
- Chapter 21 Echocardiography
- Chapter 22 Cardiovascular magnetic resonance
- Chapter 23 Cardiac computed tomography
- Part VII Congenital heart disease
- Chapter 24 Congenital heart disease
- Part VIII Obstetric cardiology
- Chapter 25 Obstetric cardiology
- Part IX Cardiac rehabilitation
- Chapter 26 Cardiac rehabilitation
- Index
(p. 182) Anti-arrhythmic drug therapy
- Chapter:
- (p. 182) Anti-arrhythmic drug therapy
- Author(s):
Dr Boon Lim
and Dr Pier Lambiase
- DOI:
- 10.1093/med/9780199594764.003.0011
The definition of a ‘landmark paper’ is multi-factorial as a paper can only be measured ultimately by its impact on clinical practice, whether positively, that is, by demonstrating the application of a specific therapy which has a significant and sustained clinical effect, or negatively, by informing the physician that therapy is not efficacious, or even dangerous. The technical criteria for such a publication should include the fact that the trial of therapy was randomized and double-blinded to avoid bias and the end points assessed should be unequivocal. The population recruited into the trial should reflect the target population treated by the physician such that it is relevant to contemporary practice. Therefore, any evaluation of landmark clinical trials of anti-arrhythmic drug therapy should begin with high quality randomized placebo controlled trials in large populations looking at key unequivocal primary end points which impact both on the individual patient and the management of populations in terms of mortality and cost-efficacy. In the anti-arrhythmic therapy field there are numerous small studies which demonstrate efficacy, but frequently the groups studied are too small to allow application to the wider population. The effects of these agents are often not pure or achieved through a single target. Figure 11.1 summarizes the main anti-arrhythmic classes, modulators of arrhythmia, and key therapeutic targets based upon arrhythmia mechanisms.
In this series of ten papers we have aimed to highlight the studies that have significantly changed or informed practice with the highest level of evidence. The series can be divided into trials of agents to prevent lethal arrhythmia and sudden death, atrial anti-arrhythmic agents (reflecting the high burden of atrial fibrillation (AF) in the community), and those trials which were important negatives, showing the detrimental effects of certain agents in specific patient populations.
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- Foreword
- Preface
- Acknowledgements
- Contributors
- List of abbreviations
- Part I Coronary heart disease
- Chapter 1 Epidemiology, outcomes, and quality of care
- Chapter 2 Lipids and cardiovascular disease
- Chapter 3 Myocardial ischaemia
- Chapter 4 Thrombosis, haemostasis, and platelet biology
- Chapter 5 Medical versus invasive management of coronary heart disease
- Chapter 6 Percutaneous coronary intervention
- Chapter 7 Percutaneous coronary intervention versus coronary artery bypass graft surgery
- Part II Cardiac electrophysiology and heart rhythm disturbances
- Chapter 8 Epidemiology and molecular foundation
- Chapter 9 Atrial fibrillation
- Chapter 10 Interventional electrophysiology
- Chapter 11 Anti-arrhythmic drug therapy
- Part III Heart failure
- Chapter 12 Epidemiology
- Chapter 13 Medical management
- Chapter 14 Cardiac resynchronization therapy
- Chapter 15 Non-ischaemic cardiomyopathy
- Chapter 16 Cardiac failure and transplantation
- Part IV Hypertension
- Chapter 17 Systemic arterial hypertension
- Chapter 18 Pulmonary arterial hypertension
- Part V Valvular heart disease
- Chapter 19 Epidemiology and intervention
- Chapter 20 Endocarditis
- Part VI Cardiac imaging
- Chapter 21 Echocardiography
- Chapter 22 Cardiovascular magnetic resonance
- Chapter 23 Cardiac computed tomography
- Part VII Congenital heart disease
- Chapter 24 Congenital heart disease
- Part VIII Obstetric cardiology
- Chapter 25 Obstetric cardiology
- Part IX Cardiac rehabilitation
- Chapter 26 Cardiac rehabilitation
- Index