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Anti-arrhythmics in critical illness 

Anti-arrhythmics in critical illness
Anti-arrhythmics in critical illness

John LeMaitre

and Jan Kornder

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date: 01 July 2022

Anti-arrhythmic drugs (AADs) are an important component of the pharmacological arsenal used in the management of the critically-ill patient. The benefits of AADs, as well as their potential disadvantageous side effects, largely depend on their effects upon the cardiac action potential. AADs can be broadly grouped according to their cellular actions, upon which their clinical effects depend. However, there is substantial cross-over amongst the groups in terms of these actions and efficacy for particular arrhythmias, and also for side effects. Amiodarone exhibits a broad spectrum of antiarrhythmic activity and is often the most useful AAD for the critically-ill patient where short-term use reduces concerns relating to toxic side effects associated with chronic administration. However, each of the other available AADs have their uses for particular scenarios in the critically-ill patient, although attention needs to be paid to comorbidities to attenuate the risk of adverse response. AADs are pro-arryhthmic in 5-10% of patients with potential lethal consequences, and the use of AADs in the critically-ill patient should be considered very carefully as correction of the underlying substrate may be sufficient in some circumstances to resolve the index arryhthmia.

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