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<title>Antiarrhythmic agent</title>

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<span id="openzim-page-title" class="mw-page-title-main"><span class="mw-page-title-main">Antiarrhythmic agent</span></span>

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</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background-color: #ddbbee">Antiarrhythmic agents</th></tr><tr><td colspan="2" class="infobox-subheader"><i><a href="Drug_class" title="Drug class">Drug class</a></i></td></tr><tr><td colspan="2" class="infobox-image"><div class="infobox-caption"><a href="Skeletal_formula" title="Skeletal formula">Skeletal formula</a> of <a href="Amiodarone" title="Amiodarone">amiodarone</a>, a common antiarrhythmic.</div></td></tr><tr><th colspan="2" class="infobox-header" style="background: #e8e8e8;">Class identifiers</th></tr><tr><th scope="row" class="infobox-label"><a href="Synonym" title="Synonym">Synonyms</a></th><td class="infobox-data">antiarrhythmics, cardiac dysrhythmia medications</td></tr><tr><th scope="row" class="infobox-label">Use</th><td class="infobox-data"><a href="Arrhythmia" title="Arrhythmia">Arrhythmia</a>, <a href="Atrial_fibrillation" title="Atrial fibrillation">Atrial fibrillation</a>, <a href="Ventricular_tachycardia" title="Ventricular tachycardia">Ventricular tachycardia</a>, etc.</td></tr><tr><th scope="row" class="infobox-label"><a href="Anatomical_Therapeutic_Chemical_Classification_System" title="Anatomical Therapeutic Chemical Classification System">ATC code</a></th><td class="infobox-data"><a href="ATC_code_C01B" class="mw-redirect" title="ATC code C01B">C01B</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Biological_target" title="Biological target">Biological target</a></th><td class="infobox-data">Cardiac ion channels</td></tr><tr><th colspan="2" class="infobox-header" style="background: #e8e8e8;">Clinical data</th></tr><tr><th scope="row" class="infobox-label"><a href="Drugs.com" title="Drugs.com">Drugs.com</a></th><td class="infobox-data"><span title="www.drugs.com"><a rel="nofollow" class="external text" href="https://www.drugs.com/drug-class/antiarrhythmic-agents.html">Drug Classes</a></span></td></tr><tr><th colspan="2" class="infobox-header" style="background: #e8e8e8;">External links</th></tr><tr><th scope="row" class="infobox-label"><a href="Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></th><td class="infobox-data"><span class="reflink nourlexpansion"><a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D000889">D000889</a></span></td></tr><tr><th colspan="2" class="infobox-header" style="background: #e8e8e8;">Legal status</th></tr><tr><td colspan="2" class="infobox-below" style="background: #e8e8e8; text-align: center"><a href="https://www.wikidata.org/wiki/Q241549" class="extiw external" title="d:Q241549">In Wikidata</a></td></tr></tbody></table>

<p><b>Antiarrhythmic agents</b>, also known as <b>cardiac dysrhythmia medications</b>, are a class of <a href="Drug" title="Drug">drugs</a> that are used to suppress abnormally fast rhythms (<a href="Tachycardia" title="Tachycardia">tachycardias</a>), such as <a href="Atrial_fibrillation" title="Atrial fibrillation">atrial fibrillation</a>, <a href="Supraventricular_tachycardia" title="Supraventricular tachycardia">supraventricular tachycardia</a> and <a href="Ventricular_tachycardia" title="Ventricular tachycardia">ventricular tachycardia</a>.

</p><p>Many attempts have been made to classify antiarrhythmic agents. Many of the antiarrhythmic agents have multiple modes of action, which makes any classification imprecise.

</p>

<div class="mw-heading mw-heading2"><h2 id="Action_potential">Action potential</h2></div>

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</style><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="Cardiac_action_potential" title="Cardiac action potential">Cardiac action potential</a></div>

<p>The cardiac myocyte has two general types of action potentials: conduction system and working myocardium. The action potential is divided into 5 phases and shown in the diagram. The sharp rise in voltage ("0") corresponds to the influx of sodium ions, whereas the two decays ("1" and "3", respectively) correspond to the sodium-channel inactivation and the repolarizing efflux of potassium ions. The characteristic plateau ("2") results from the opening of voltage-sensitive <a href="Calcium_channel" title="Calcium channel">calcium channels</a>. Each phase utilizes different channels and it is useful to compare these phases to the most common classification system — Vaughan Williams — described below.

</p>

<div class="mw-heading mw-heading2"><h2 id="Vaughan_Williams_classification">Vaughan Williams classification</h2></div>

<p>The <b>Vaughan Williams classification</b><sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> was introduced in 1970 by <a href="Miles_Vaughan_Williams" title="Miles Vaughan Williams">Miles Vaughan Williams</a>.<sup id="cite_ref-VW70_2-0" class="reference"><a href="#cite_note-VW70-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup>

</p><p>Vaughan Williams was a pharmacology tutor at <a href="Hertford_College" class="mw-redirect" title="Hertford College">Hertford College</a>, Oxford. One of his students, <a href="Bramah_N._Singh" title="Bramah N. Singh">Bramah N. Singh</a>,<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> contributed to the development of the classification system. The system is therefore sometimes known as the <b>Singh-Vaughan Williams classification</b>.

</p><p>The five main classes in the Vaughan Williams classification of antiarrhythmic agents are:

</p>

<ul><li><b>Class I</b> agents interfere with the <a href="Sodium" title="Sodium">sodium</a> (Na<sup>+</sup>) channel.</li>

<li><b>Class II</b> agents are anti-<a href="Sympathetic_nervous_system" title="Sympathetic nervous system">sympathetic nervous system</a> agents. Most agents in this class are <a href="Beta_blockers" class="mw-redirect" title="Beta blockers">beta blockers</a>.</li>

<li><b>Class III</b> agents affect <a href="Potassium" title="Potassium">potassium</a> (K<sup>+</sup>) efflux.</li>

<li><b>Class IV</b> agents affect <a href="Calcium" title="Calcium">calcium</a> channels and the <a href="AV_node" class="mw-redirect" title="AV node">AV node</a>.</li>

<li><b>Class V</b> agents work by other or unknown mechanisms.</li></ul>

<p>With regard to management of atrial fibrillation, classes I and III are used in rhythm control as medical cardioversion agents, while classes II and IV are used as rate-control agents.

</p>

<th>Class

</th>

<th>Known as

</th>

<th>Examples

</th>

<th>Mechanism

</th>

<th>Medical uses<sup id="cite_ref-Rangunless_4-0" class="reference"><a href="#cite_note-Rangunless-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup>

</th></tr>

<tr>

<th>Ia

</th>

<td>Fast sodium channel blockers

</td>

<td>

<ul><li><a href="Ajmaline" title="Ajmaline">Ajmaline</a></li>

<li><a href="Disopyramide" title="Disopyramide">Disopyramide</a></li>

<li><a href="Procainamide" title="Procainamide">Procainamide</a></li>

<li><a href="Quinidine" title="Quinidine">Quinidine</a></li>

<li><a href="Sparteine" title="Sparteine">Sparteine</a></li></ul>

</td>

<td><a href="Sodium_channel" title="Sodium channel">Na<sup>+</sup> channel</a> block (intermediate association/dissociation) and K+ channel blocking effect.

<p>Class Ia drugs prolong the action potential and has an intermediate effect on the 0 phase of depolarization.

</p>

</td>

<td>

<ul><li>Increase QT interval</li>

<li>Prevent paroxysmal recurrent <a href="Atrial_fibrillation" title="Atrial fibrillation">atrial fibrillation</a> triggered by <a href="Vagus_nerve" title="Vagus nerve">vagal</a> overactivity</li>

<li>Treat ventricular <a href="Arrhythmia" title="Arrhythmia">arrhythmia</a></li>

<li>Treat <a href="Wolff-Parkinson-White_syndrome" class="mw-redirect" title="Wolff-Parkinson-White syndrome">Wolff-Parkinson-White syndrome</a> (procainamide with caution)</li></ul>

</td></tr>

<tr>

<th>Ib

</th>

<td>

</td>

<td>

<ul><li><a href="Lidocaine" title="Lidocaine">Lidocaine</a></li>

<li><a href="Mexiletine" title="Mexiletine">Mexiletine</a></li>

<li><a href="Phenytoin" title="Phenytoin">Phenytoin</a></li>

<li><a href="Tocainide" title="Tocainide">Tocainide</a></li></ul>

</td>

<td>Na<sup>+</sup> channel block (fast association/dissociation).

<p>Class Ib drugs shorten the action potential of myocardial cell and has a weak effect on the initiation of phase 0 of depolarization

</p>

</td>

<td>

<ul><li>Treat and prevent ventricular <a href="Arrhythmia" title="Arrhythmia">arrhythmia</a> during and immediately after <a href="Myocardial_infarction" title="Myocardial infarction">myocardial infarction</a>, though this is now discouraged given the increased risk of <a href="Asystole" title="Asystole">asystole</a></li></ul>

</td></tr>

<tr>

<th>Ic

</th>

<td>

</td>

<td>

<ul><li><a href="Encainide" title="Encainide">Encainide</a></li>

<li><a href="Flecainide" title="Flecainide">Flecainide</a></li>

<li><a href="Moricizine" class="mw-redirect" title="Moricizine">Moricizine</a></li>

<li><a href="Propafenone" title="Propafenone">Propafenone</a></li></ul>

</td>

<td>Na<sup>+</sup> channel block (slow association/dissociation).

<p>Class Ic drugs do not affect action potential duration and have the strongest effect on the initiation phase 0 of depolarization

</p>

</td>

<td>

<ul><li>Contraindicated immediately after myocardial infarction</li>

<li>Prevent paroxysmal <a href="Atrial_fibrillation" title="Atrial fibrillation">atrial fibrillation</a></li>

<li>Treat recurrent <a href="Tachycardia" title="Tachycardia">tachycardia</a> associated with abnormal <a href="Electrical_conduction_system_of_the_heart" class="mw-redirect" title="Electrical conduction system of the heart">conduction pathways</a>, such as <a href="Wolff%E2%80%93Parkinson%E2%80%93White_syndrome" title="Wolff–Parkinson–White syndrome">Wolff–Parkinson–White syndrome</a></li></ul>

</td></tr>

<tr>

<th>II

</th>

<td>Beta-blockers

</td>

<td>

<ul><li><a href="Atenolol" title="Atenolol">Atenolol</a></li>

<li><a href="Bisoprolol" title="Bisoprolol">Bisoprolol</a></li>

<li><a href="Carvedilol" title="Carvedilol">Carvedilol</a></li>

<li><a href="Esmolol" title="Esmolol">Esmolol</a></li>

<li><a href="Metoprolol" title="Metoprolol">Metoprolol</a></li>

<li><a href="Nebivolol" title="Nebivolol">Nebivolol</a></li>

<li><a href="Propranolol" title="Propranolol">Propranolol</a></li>

<li><a href="Timolol" title="Timolol">Timolol</a></li></ul>

</td>

<td><a href="Beta_blocker" title="Beta blocker">Beta blocker</a><br>Propranolol also has some sodium channel-blocking effect.

</td>

<td>

<ul><li>Decrease mortality in patients with <a href="Myocardial_infarction" title="Myocardial infarction">myocardial infarction</a></li>

<li>Prevent recurrence of <a href="Tachycardia" title="Tachycardia">tachycardia</a></li></ul>

</td></tr>

<tr>

<th>III

</th>

<td>Potassium channel blockers

</td>

<td>

<ul><li><a href="Amiodarone" title="Amiodarone">Amiodarone</a></li>

<li><a href="Dofetilide" title="Dofetilide">Dofetilide</a></li>

<li><a href="Dronedarone" title="Dronedarone">Dronedarone</a></li>

<li><a href="Ibutilide" title="Ibutilide">Ibutilide</a></li>

<li><a href="Sotalol" title="Sotalol">Sotalol</a></li>

<li><a href="Vernakalant" title="Vernakalant">Vernakalant</a></li></ul>

</td>

<td><a href="Potassium_channel_blocker" title="Potassium channel blocker">K<sup>+</sup> channel blocker</a>

<p><a href="Sotalol" title="Sotalol">Sotalol</a> is also a <a href="Beta_blocker" title="Beta blocker">beta blocker</a><sup id="cite_ref-pmid11350865_5-0" class="reference"><a href="#cite_note-pmid11350865-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><br>

<a href="Amiodarone" title="Amiodarone">Amiodarone</a> has mostly Class III activity, but also I, II, & IV activity<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup>

</p>

</td>

<td>

<ul><li>Prevent paroxysmal atrial fibrillation<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> and haemodynamically stable ventricular tachycardia<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> (amiodarone)</li>

<li>Treat <a href="Atrial_flutter" title="Atrial flutter">atrial flutter</a> and atrial fibrillation (ibutilide)</li>

<li>Treat <a href="Ventricular_tachycardia" title="Ventricular tachycardia">ventricular tachycardia</a> and <a href="Atrial_fibrillation" title="Atrial fibrillation">atrial fibrillation</a> (sotalol)</li>

<li>Treat <a href="Wolff-Parkinson-White_syndrome" class="mw-redirect" title="Wolff-Parkinson-White syndrome">Wolff-Parkinson-White syndrome</a></li></ul>

</td></tr>

<tr>

<th>IV

</th>

<td>Calcium channel blockers

</td>

<td>

<ul><li><a href="Diltiazem" title="Diltiazem">Diltiazem</a></li>

<li><a href="Verapamil" title="Verapamil">Verapamil</a></li></ul>

</td>

<td><a href="Calcium_channel_blocker" title="Calcium channel blocker">Ca<sup>2+</sup> channel blocker</a>

</td>

<td>

<ul><li>Prevent recurrence of <a href="Paroxysmal_supraventricular_tachycardia" title="Paroxysmal supraventricular tachycardia">paroxysmal supraventricular tachycardia</a></li>

<li>Reduce <a href="Ventricular_rate" class="mw-redirect" title="Ventricular rate">ventricular rate</a> in patients with <a href="Atrial_fibrillation" title="Atrial fibrillation">atrial fibrillation</a></li></ul>

</td></tr>

<tr>

<th>V

</th>

<td>

</td>

<td>

<ul><li><a href="Adenosine" title="Adenosine">Adenosine</a></li>

<li><a href="Digoxin" title="Digoxin">Digoxin</a></li>

<li><a href="Magnesium_sulfate_(medical_use)" class="mw-redirect" title="Magnesium sulfate (medical use)">Magnesium sulfate</a></li></ul>

</td>

<td>Work by other or unknown mechanisms

</td>

<td>

<ul><li>Contraindicated in ventricular arrhythmias</li>

<li>Adenosine is used to treat <a href="Supraventricular_tachycardia" title="Supraventricular tachycardia">supraventricular tachycardias</a>, especially in heart failure and atrial fibrillation<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup></li>

<li>Magnesium sulfate is used to treat <i><a href="Torsades_de_pointes" title="Torsades de pointes">torsades de pointes</a></i>, a type of arrhythmia</li></ul>

</td></tr>

</tbody></table>

<div class="mw-heading mw-heading3"><h3 id="Class_I_agents">Class I agents</h3></div>

<p>The class I antiarrhythmic agents <a href="Sodium_channel_blocker" title="Sodium channel blocker">interfere with the sodium channel</a>.

Class I agents are grouped by what effect they have on the Na<sup>+</sup> channel, and what effect they have on cardiac <a href="Action_potential" title="Action potential">action potentials</a>.

</p><p>Class I agents are called membrane-stabilizing agents, "stabilizing" referring to the decrease of excitogenicity of the plasma membrane which is brought about by these agents. (Also noteworthy is that a few class II agents like propranolol also have a <a href="Membrane_stabilizing_effect" title="Membrane stabilizing effect">membrane stabilizing effect</a>.)

</p><p>Class I agents are divided into three groups (Ia, Ib, and Ic) based upon their effect on the length of the action potential.<sup id="cite_ref-pmid6723689_10-0" class="reference"><a href="#cite_note-pmid6723689-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-isbn0-07-139930-5_11-0" class="reference"><a href="#cite_note-isbn0-07-139930-5-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup>

</p>

<ul><li>Class Ia drugs lengthen the action potential (right shift)</li>

<li>Class Ib drugs shorten the action potential (left shift)</li>

<li>Class Ic drugs do not significantly affect the action potential (no shift)</li></ul>

<div class="gallerytext">Class Ia</div>

</li>

<div class="gallerytext">Class Ib</div>

</li>

<div class="gallerytext">Class Ic</div>

</li>

</ul>

</div>

<div class="mw-heading mw-heading3"><h3 id="Class_II_agents">Class II agents</h3></div>

<p>Class II agents are conventional <a href="Beta_blockers" class="mw-redirect" title="Beta blockers">beta blockers</a>. They act by blocking the effects of <a href="Catecholamine" title="Catecholamine">catecholamines</a> at the <a href="Adrenergic_receptor#β1_receptor" title="Adrenergic receptor">β<sub>1</sub>-adrenergic receptors</a>, thereby decreasing sympathetic activity on the heart, which reduces intracellular cAMP levels and hence reduces Ca<sup>2+</sup> influx. These agents are particularly useful in the treatment of <a href="Supraventricular_tachycardia" title="Supraventricular tachycardia">supraventricular tachycardias</a>. They decrease conduction through the <a href="AV_node" class="mw-redirect" title="AV node">AV node</a>.

</p><p>Class II agents include <a href="Atenolol" title="Atenolol">atenolol</a>, <a href="Esmolol" title="Esmolol">esmolol</a>, <a href="Propranolol" title="Propranolol">propranolol</a>, and <a href="Metoprolol" title="Metoprolol">metoprolol</a>.

</p>

<div class="mw-heading mw-heading3"><h3 id="Class_III_agents">Class III agents</h3></div>

<p>Class III agents predominantly <a href="Potassium_channel_blocker" title="Potassium channel blocker">block the potassium channels</a>, thereby prolonging repolarization.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Since these agents do not affect the sodium channel, conduction velocity is not decreased. The prolongation of the action potential duration and refractory period, combined with the maintenance of normal conduction velocity, prevent re-entrant arrhythmias. (The re-entrant rhythm is less likely to interact with tissue that has become refractory). The class III agents exhibit reverse-use dependence (their potency increases with slower heart rates, and therefore improves maintenance of sinus rhythm). Inhibiting potassium channels results in slowed atrial-ventricular myocyte repolarization. Class III agents have the potential to prolong the QT interval of the EKG, and may be proarrhythmic (more associated with development of polymorphic VT).

</p><p>Class III agents include: <a href="Bretylium" title="Bretylium">bretylium</a>, <a href="Amiodarone" title="Amiodarone">amiodarone</a>, <a href="Ibutilide" title="Ibutilide">ibutilide</a>, <a href="Sotalol" title="Sotalol">sotalol</a>, <a href="Dofetilide" title="Dofetilide">dofetilide</a>, <a href="Vernakalant" title="Vernakalant">vernakalant</a>, and <a href="Dronedarone" title="Dronedarone">dronedarone</a>.

</p>

<div class="mw-heading mw-heading3"><h3 id="Class_IV_agents">Class IV agents</h3></div>

<p>Class IV agents are slow <a href="Calcium_channel_blocker#Non-dihydropyridine" title="Calcium channel blocker">non-dihydropyridine</a> <a href="Calcium_channel_blocker" title="Calcium channel blocker">calcium channel blockers</a>. They decrease conduction through the <a href="AV_node" class="mw-redirect" title="AV node">AV node</a>, and shorten phase two (the plateau) of the <a href="Cardiac_action_potential" title="Cardiac action potential">cardiac action potential</a>. They thus reduce the contractility of the heart, so may be inappropriate in heart failure. However, in contrast to beta blockers, they allow the body to retain adrenergic control of heart rate and contractility.

</p><p>Class IV agents include <a href="Verapamil" title="Verapamil">verapamil</a> and <a href="Diltiazem" title="Diltiazem">diltiazem</a>.

</p>

<div class="mw-heading mw-heading3"><h3 id="Class_V_and_others">Class V and others</h3></div>

<p>Since the development of the original Vaughan Williams classification system, additional agents have been used that do not fit cleanly into categories I through IV. Such agents include:

</p>

<ul><li><a href="Adenosine" title="Adenosine">Adenosine</a> is used intravenously for terminating <a href="Supraventricular_tachycardia" title="Supraventricular tachycardia">supraventricular tachycardias</a>.<sup id="cite_ref-pmid7882485_13-0" class="reference"><a href="#cite_note-pmid7882485-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup></li>

<li><a href="Digoxin" title="Digoxin">Digoxin</a> decreases conduction of electrical impulses through the AV node and increases vagal activity via its action on the central nervous system. Via indirect action, it leads to an increase in <a href="Acetylcholine" title="Acetylcholine">acetylcholine</a> production, stimulating M2 receptors on AV node leading to an overall decrease in speed of conduction.</li>

<li><a href="Magnesium_sulfate" title="Magnesium sulfate">Magnesium sulfate</a> is an antiarrhythmic drug, but only used against very specific arrhythmias<sup id="cite_ref-pmid10924290_14-0" class="reference"><a href="#cite_note-pmid10924290-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> such as <a href="Torsades_de_pointes" title="Torsades de pointes">torsades de pointes</a>.<sup id="cite_ref-pmid15466950_15-0" class="reference"><a href="#cite_note-pmid15466950-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid16635167_16-0" class="reference"><a href="#cite_note-pmid16635167-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup></li></ul>

<div class="mw-heading mw-heading3"><h3 id="History">History</h3></div>

<p>The initial classification system had 4 classes, although their definitions different from the modern classification. Those proposed in 1970 were:<sup id="cite_ref-VW70_2-1" class="reference"><a href="#cite_note-VW70-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup>

</p>

<ol><li>Drugs with a direct membrane action: the prototype was <a href="Quinidine" title="Quinidine">quinidine</a>, and <a href="Lidocaine" title="Lidocaine">lignocaine</a> was a key example. Differing from other authors, Vaughan-Williams describe the main action as a slowing of the rising phase of the action potential.</li>

<li>Sympatholytic drugs (drugs blocking the effects of the <a href="Sympathetic_nervous_system" title="Sympathetic nervous system">sympathetic nervous system</a>): examples included <a href="Bretylium" title="Bretylium">bretylium</a> and <a href="Beta_blocker" title="Beta blocker">adrenergic beta-receptors blocking drugs</a>. This is similar to the modern classification, which focuses on the latter category.</li>

<li>Compounds that prolong the action potential: matching the modern classification, with the key drug example being <a href="Amiodarone" title="Amiodarone">amiodarone</a>, and a surgical example being <a href="Thyroidectomy" title="Thyroidectomy">thyroidectomy</a>. This was not a defining characteristic in an earlier review by Charlier et al. (1968),<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> but was supported by experimental data presented by Vaughan Williams (1970).<sup id="cite_ref-VW70_2-2" class="reference"><a href="#cite_note-VW70-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page: 461">: 461 </span></sup> The figure illustrating these findings was also published in the same year by Singh and Vaughan Williams.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup></li>

<li>Drugs acting like <a href="Diphenylhydantoin" class="mw-redirect" title="Diphenylhydantoin">diphenylhydantoin</a> (DPH): mechanism of action unknown, but others had attributed its cardiac action to an indirect action on the brain;<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> this drug is better known as antiepileptic drug <a href="Phenytoin" title="Phenytoin">phenytoin</a>.</li></ol>

<div class="mw-heading mw-heading2"><h2 id="Sicilian_gambit_classification">Sicilian gambit classification</h2></div>

<p>Another approach, known as the "Sicilian gambit", placed a greater approach on the underlying mechanism.<sup id="cite_ref-pmid1723682_20-0" class="reference"><a href="#cite_note-pmid1723682-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid1474169_21-0" class="reference"><a href="#cite_note-pmid1474169-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup>

</p><p>It presents the drugs on two axes, instead of one, and is presented in tabular form. On the Y axis, each drug is listed, in roughly the Singh-Vaughan Williams order. On the X axis, the channels, receptors, pumps, and clinical effects are listed for each drug, with the results listed in a grid. It is, therefore, not a true classification in that it does not aggregate drugs into categories.<sup id="cite_ref-isbn0-86542-532-9_23-0" class="reference"><a href="#cite_note-isbn0-86542-532-9-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup>

</p>

<div class="mw-heading mw-heading2"><h2 id="Modernized_Oxford_classification_by_Lei,_Huang,_Wu,_and_Terrar">Modernized Oxford classification by Lei, Huang, Wu, and Terrar</h2></div>

<p>A recent publication (2018) has now emerged with a fully modernised drug classification.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> This preserves the simplicity of the original Vaughan Williams framework while capturing subsequent discoveries of sarcolemmal, sarcoplasmic reticular and cytosolic biomolecules. The result is an expanded but pragmatic classification that encompasses approved and potential anti-arrhythmic drugs. This will aid our understanding and clinical management of cardiac arrhythmias and facilitate future therapeutic developments. It starts by considering the range of pharmacological targets, and tracks these to their particular cellular electrophysiological effects. It retains but expands the original Vaughan Williams classes I to IV, respectively covering actions on Na+ current components, autonomic signalling, K<sup>+</sup> channel subspecies, and molecular targets related to <a href="Calcium_metabolism#Intracellular_signalling" title="Calcium metabolism">Ca<sup>2+</sup> homeostasis</a>. It now introduces new classes incorporating additional targets, including:

</p>

<ul><li>Class 0: ion channels involved in automaticity</li>

<li>Class V: mechanically sensitive ion channels</li>

<li>Class VI: connexins controlling electrotonic cell coupling</li>

<li>Class VII: molecules underlying longer term signalling processes affecting structural remodeling.</li></ul>

<p>It also allows for multiple drug targets/actions and adverse pro-arrhythmic effects. The new scheme will additionally aid development of novel drugs under development and is illustrated here.

</p>

<ul><li>Antiarrhythmic agents (category)</li>

<li><a href="Cardiac_Arrhythmia_Suppression_Trial" title="Cardiac Arrhythmia Suppression Trial">Cardiac Arrhythmia Suppression Trial</a> (CAST)</li>

<li><a href="Electrocardiogram" class="mw-redirect" title="Electrocardiogram">Electrocardiogram</a></li>

<li><a href="Management_of_atrial_fibrillation" class="mw-redirect" title="Management of atrial fibrillation">Management of atrial fibrillation</a></li>

<li><a href="Proarrhythmic_agent" title="Proarrhythmic agent">Proarrhythmic agent</a></li></ul>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

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<li id="cite_note-18"><span class="mw-cite-backlink"><b><a href="#cite_ref-18">^</a></b></span> <span class="reference-text"><cite id="CITEREFSinghVaughan_Williams1970" class="citation journal cs1">Singh, BN; Vaughan Williams, EM (August 1970). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1702721">"The effect of amiodarone, a new anti-anginal drug, on cardiac muscle"</a>. <i>British Journal of Pharmacology</i>. <b>39</b> (4): <span class="nowrap">657–</span>667. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1476-5381.1970.tb09891.x">10.1111/j.1476-5381.1970.tb09891.x</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1702721">1702721</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/5485142">5485142</a>.</cite></span>

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<li id="cite_note-19"><span class="mw-cite-backlink"><b><a href="#cite_ref-19">^</a></b></span> <span class="reference-text"><cite id="CITEREFDamato1969" class="citation journal cs1">Damato, Anthony N. (1 July 1969). "Diphenylhydantoin: Pharmacological and clinical use". <i>Progress in Cardiovascular Diseases</i>. <b>12</b> (1): <span class="nowrap">1–</span>15. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2F0033-0620%2869%2990032-2">10.1016/0033-0620(69)90032-2</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/5807584">5807584</a>.</cite></span>

</li>

<li id="cite_note-pmid1723682-20"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid1723682_20-0">^</a></b></span> <span class="reference-text"><cite class="citation journal cs1">"The 'Sicilian Gambit'. A new approach to the classification of antiarrhythmic drugs based on their actions on arrhythmogenic mechanisms. The Task Force of the Working Group on Arrhythmias of the European Society of Cardiology". <i>Eur. Heart J</i>. <b>12</b> (10): <span class="nowrap">1112–</span>1131. October 1991. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/1723682">1723682</a>.</cite></span>

</li>

<li id="cite_note-pmid1474169-21"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid1474169_21-0">^</a></b></span> <span class="reference-text"><cite id="CITEREFVaughan_Williams_EM1992" class="citation journal cs1">Vaughan Williams EM (November 1992). "Classifying antiarrhythmic actions: by facts or speculation". <i>J Clin Pharmacol</i>. <b>32</b> (11): <span class="nowrap">964–</span>977. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1002%2Fj.1552-4604.1992.tb03797.x">10.1002/j.1552-4604.1992.tb03797.x</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/1474169">1474169</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:70464824">70464824</a>.</cite></span>

</li>

<li id="cite_note-22"><span class="mw-cite-backlink"><b><a href="#cite_ref-22">^</a></b></span> <span class="reference-text"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.medscape.com/viewarticle/412798_3">"Milestones in the Evolution of the Study of Arrhythmias"</a><span class="reference-accessdate">. Retrieved <span class="nowrap">2008-07-31</span></span>.</cite> </span>

</li>

<li id="cite_note-isbn0-86542-532-9-23"><span class="mw-cite-backlink"><b><a href="#cite_ref-isbn0-86542-532-9_23-0">^</a></b></span> <span class="reference-text"><cite id="CITEREFFogoros,_Richard_N.1997" class="citation book cs1">Fogoros, Richard N. (1997). <i>Antiarrhythmic drugs: a practical guide</i>. Oxford: Blackwell Science. p. 49. <a href="ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <bdi>978-0-86542-532-3</bdi>.</cite></span>

</li>

<li id="cite_note-24"><span class="mw-cite-backlink"><b><a href="#cite_ref-24">^</a></b></span> <span class="reference-text"><cite id="CITEREFLeiWuTerrarHuang2018" class="citation journal cs1">Lei, Ming; Wu, Lin; Terrar, Derek A.; Huang, Christopher L.-H. (23 October 2018). <a rel="nofollow" class="external text" href="https://doi.org/10.1161%2FCIRCULATIONAHA.118.035455">"Modernized Classification of Cardiac Antiarrhythmic Drugs"</a>. <i>Circulation</i>. <b>138</b> (17): <span class="nowrap">1879–</span>1896. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1161%2FCIRCULATIONAHA.118.035455">10.1161/CIRCULATIONAHA.118.035455</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/30354657">30354657</a>.</cite></span>

</li>

</ol></div></div>

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</style><div id="Major_chemical_drug_groups_–_based_upon_the_Anatomical_Therapeutic_Chemical_Classification_System1398" style="font-size:114%;margin:0 4em">Major chemical drug groups – based upon the <a href="Anatomical_Therapeutic_Chemical_Classification_System" title="Anatomical Therapeutic Chemical Classification System">Anatomical Therapeutic Chemical Classification System</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Human_gastrointestinal_tract" class="mw-redirect" title="Human gastrointestinal tract">gastrointestinal tract</a><br>/ <a href="Metabolism" title="Metabolism">metabolism</a> (<a href="ATC_code_A" title="ATC code A">A</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><i>stomach acid</i>

<ul><li><a href="Antacid" title="Antacid">Antacids</a></li>

<li><a href="H2_antagonist" class="mw-redirect" title="H2 antagonist">H<sub>2</sub> antagonists</a></li>

<li><a href="Proton-pump_inhibitor" title="Proton-pump inhibitor">Proton-pump inhibitors</a></li></ul></li>

<li><a href="Antiemetic" title="Antiemetic">Antiemetics</a></li>

<li><a href="Laxative" title="Laxative">Laxatives</a></li>

<li><a href="Antidiarrhoeal" class="mw-redirect" title="Antidiarrhoeal">Antidiarrhoeals</a> / <a href="Antipropulsive" title="Antipropulsive">Antipropulsives</a></li>

<li><a href="Anti-obesity_medication" title="Anti-obesity medication">Anti-obesity drugs</a></li>

<li><a href="Diabetes_medication" title="Diabetes medication">Diabetes medication</a></li>

<li><a href="Vitamin" title="Vitamin">Vitamins</a></li>

<li><a href="Dietary_mineral" class="mw-redirect" title="Dietary mineral">Dietary minerals</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Blood" title="Blood">blood</a> and blood<br>forming organs (<a href="ATC_code_B" title="ATC code B">B</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Antithrombotic" title="Antithrombotic">Antithrombotics</a>

<ul><li><a href="Antiplatelet_drug" title="Antiplatelet drug">Antiplatelets</a></li>

<li><a href="Anticoagulant" title="Anticoagulant">Anticoagulants</a></li>

<li><a href="Thrombolytic_drug" class="mw-redirect" title="Thrombolytic drug">Thrombolytics / fibrinolytics</a></li></ul></li>

<li><a href="Antihemorrhagic" title="Antihemorrhagic">Antihemorrhagics</a>

<ul><li><a href="Platelet" title="Platelet">Platelets</a></li>

<li><a href="Coagulation" title="Coagulation">Coagulants</a></li>

<li><a href="Antifibrinolytic" title="Antifibrinolytic">Antifibrinolytics</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Circulatory_system" title="Circulatory system">cardiovascular<br>system</a> (<a href="ATC_code_C" title="ATC code C">C</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><i>cardiac therapy / <a href="Antianginal" title="Antianginal">antianginals</a></i>

<ul><li><a href="Cardiac_glycoside" title="Cardiac glycoside">Cardiac glycosides</a></li>

<li><a href="Cardiac_stimulant" title="Cardiac stimulant">Cardiac stimulants</a></li></ul></li>

<li><a href="Antihypertensive_drug" class="mw-redirect" title="Antihypertensive drug">Antihypertensives</a></li>

<li><a href="Diuretic" title="Diuretic">Diuretics</a></li>

<li><a href="Vasodilation" title="Vasodilation">Vasodilators</a></li>

<li><a href="Beta_blocker" title="Beta blocker">Beta blockers</a></li>

<li><a href="Calcium_channel_blocker" title="Calcium channel blocker">Calcium channel blockers</a></li>

<li><i><a href="Renin%E2%80%93angiotensin_system" title="Renin–angiotensin system">renin–angiotensin system</a></i>

<ul><li><a href="ACE_inhibitor" title="ACE inhibitor">ACE inhibitors</a></li>

<li><a href="Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">Angiotensin II receptor antagonists</a></li>

<li><a href="Renin_inhibitor" title="Renin inhibitor">Renin inhibitors</a></li></ul></li>

<li><a href="Hypolipidemic_agent" class="mw-redirect" title="Hypolipidemic agent">Antihyperlipidemics</a>

<ul><li><a href="Statin" title="Statin">Statins</a></li>

<li><a href="Fibrate" title="Fibrate">Fibrates</a></li>

<li><a href="Bile_acid_sequestrant" title="Bile acid sequestrant">Bile acid sequestrants</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Human_skin" title="Human skin">skin</a> (<a href="ATC_code_D" title="ATC code D">D</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Emollient" class="mw-redirect" title="Emollient">Emollients</a></li>

<li><a href="Cicatrizant" class="mw-redirect" title="Cicatrizant">Cicatrizants</a></li>

<li><a href="Antipruritic" title="Antipruritic">Antipruritics</a></li>

<li><a href="Antipsoriatic" class="mw-redirect" title="Antipsoriatic">Antipsoriatics</a></li>

<li><a href="ATC_code_D09" title="ATC code D09">Medicated dressings</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Genitourinary_system" title="Genitourinary system">genitourinary<br>system</a> (<a href="ATC_code_G" title="ATC code G">G</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Hormonal_contraception" title="Hormonal contraception">Hormonal contraception</a></li>

<li><a href="Fertility_medication" title="Fertility medication">Fertility agents</a></li>

<li><a href="Selective_estrogen_receptor_modulator" title="Selective estrogen receptor modulator">Selective estrogen receptor modulators</a></li>

<li><a href="Sex_steroid" class="mw-redirect" title="Sex steroid">Sex hormones</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Endocrine_system" title="Endocrine system">endocrine<br>system</a> (<a href="ATC_code_H" title="ATC code H">H</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Hypothalamic%E2%80%93pituitary_hormone" title="Hypothalamic–pituitary hormone">Hypothalamic–pituitary hormones</a></li>

<li><a href="Corticosteroid" title="Corticosteroid">Corticosteroids</a>

<ul><li><a href="Glucocorticoid" title="Glucocorticoid">Glucocorticoids</a></li>

<li><a href="Mineralocorticoid" title="Mineralocorticoid">Mineralocorticoids</a></li></ul></li>

<li><a href="Sex_steroid" class="mw-redirect" title="Sex steroid">Sex hormones</a></li>

<li><a href="Thyroid_hormone" class="mw-redirect" title="Thyroid hormone">Thyroid hormones</a> / <a href="Antithyroid_agent" title="Antithyroid agent">Antithyroid agents</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Infection" title="Infection">infections</a> and<br><a href="https://en.wiktionary.org/wiki/infestation" class="extiw external" title="wikt:infestation">infestations</a> (<a href="ATC_code_J" title="ATC code J">J</a>, <a href="ATC_code_P" title="ATC code P">P</a>, <a href="ATCvet_code_QI" title="ATCvet code QI">QI</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Antimicrobial" title="Antimicrobial">Antimicrobials</a>: <a href="Antibacterial" class="mw-redirect" title="Antibacterial">Antibacterials</a> (<a href="Antimycobacterial" title="Antimycobacterial">Antimycobacterials</a>)</li>

<li><a href="Antifungal_drug" class="mw-redirect" title="Antifungal drug">Antifungals</a></li>

<li><a href="Antiviral_drug" title="Antiviral drug">Antivirals</a></li>

<li><a href="Antiparasitic" title="Antiparasitic">Antiparasitics</a>

<ul><li><a href="Antiprotozoal_agent" class="mw-redirect" title="Antiprotozoal agent">Antiprotozoals</a></li>

<li><a href="Anthelmintic" title="Anthelmintic">Anthelmintics</a></li>

<li><a href="Ectoparasiticide" title="Ectoparasiticide">Ectoparasiticides</a></li></ul></li>

<li><a href="Intravenous_immunoglobulin" class="mw-redirect" title="Intravenous immunoglobulin">Intravenous immunoglobulin</a></li>

<li><a href="Vaccine" title="Vaccine">Vaccines</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Malignant" class="mw-redirect" title="Malignant">malignant</a> disease<br>(<a href="ATC_code_L" title="ATC code L">L01–L02</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Chemotherapy" title="Chemotherapy">Anticancer agents</a>

<ul><li><a href="Antimetabolite" title="Antimetabolite">Antimetabolites</a></li>

<li><a href="Alkylating_antineoplastic_agent" title="Alkylating antineoplastic agent">Alkylating</a></li>

<li><a href="Spindle_poison" title="Spindle poison">Spindle poisons</a></li>

<li><a href="Antineoplastic" class="mw-redirect" title="Antineoplastic">Antineoplastic</a></li>

<li><a href="Topoisomerase_inhibitor" title="Topoisomerase inhibitor">Topoisomerase inhibitors</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Immune_system" title="Immune system">immune</a> disease<br>(<a href="ATC_code_L" title="ATC code L">L03–L04</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Immunomodulator" class="mw-redirect" title="Immunomodulator">Immunomodulators</a>

<ul><li><a href="Immunostimulant" title="Immunostimulant">Immunostimulants</a></li>

<li><a href="Immunosuppressive_drug" title="Immunosuppressive drug">Immunosuppressants</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Muscle" title="Muscle">muscles</a>, <a href="Bone" title="Bone">bones</a>,<br>and <a href="Joint" title="Joint">joints</a> (<a href="ATC_code_M" title="ATC code M">M</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Anabolic_steroid" title="Anabolic steroid">Anabolic steroids</a></li>

<li><a href="Anti-inflammatory" title="Anti-inflammatory">Anti-inflammatories</a>

<ul><li><a href="Non-steroidal_anti-inflammatory_drug" class="mw-redirect" title="Non-steroidal anti-inflammatory drug">Non-steroidal anti-inflammatory drugs</a></li></ul></li>

<li><a href="Disease-modifying_antirheumatic_drug" title="Disease-modifying antirheumatic drug">Antirheumatics</a></li>

<li><a href="Corticosteroid" title="Corticosteroid">Corticosteroids</a></li>

<li><a href="Muscle_relaxant" title="Muscle relaxant">Muscle relaxants</a></li>

<li><a href="Bisphosphonate" title="Bisphosphonate">Bisphosphonates</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Human_brain" title="Human brain">brain</a> and<br><a href="Nervous_system" title="Nervous system">nervous system</a> (<a href="ATC_code_N" title="ATC code N">N</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Analgesic" title="Analgesic">Analgesics</a></li>

<li><a href="Anesthetic" title="Anesthetic">Anesthetics</a>

<ul><li><a href="General_anaesthetic" title="General anaesthetic">General</a></li>

<li><a href="Local_anesthetic" title="Local anesthetic">Local</a></li></ul></li>

<li><a href="Anorectic" title="Anorectic">Anorectics</a></li>

<li><a href="Antihyperkinetic" class="mw-redirect" title="Antihyperkinetic">Anti-ADHD agents</a></li>

<li><a href="Addiction_medicine" title="Addiction medicine">Antiaddictives</a></li>

<li><a href="Anticonvulsant" title="Anticonvulsant">Anticonvulsants</a></li>

<li><a href="Antidementia_drug" class="mw-redirect" title="Antidementia drug">Antidementia agents</a></li>

<li><a href="Antidepressant" title="Antidepressant">Antidepressants</a></li>

<li><a href="Antimigraine_drug" title="Antimigraine drug">Antimigraine agents</a></li>

<li><a href="Management_of_Parkinson's_disease#Medication" title="Management of Parkinson's disease">Antiparkinson agents</a></li>

<li><a href="Antipsychotic" title="Antipsychotic">Antipsychotics</a></li>

<li><a href="Anxiolytic" title="Anxiolytic">Anxiolytics</a></li>

<li><a href="Aphrodisiac" title="Aphrodisiac">Aphrodisiacs</a></li>

<li><a href="Depressant" title="Depressant">Depressants</a></li>

<li><a href="Entactogen" title="Entactogen">Entactogens</a></li>

<li><a href="Entheogen" title="Entheogen">Entheogens</a></li>

<li><a href="Euphoriant" class="mw-redirect" title="Euphoriant">Euphoriants</a></li>

<li><a href="Hallucinogen" title="Hallucinogen">Hallucinogens</a>

<ul><li><a href="Psychedelic_drug" title="Psychedelic drug">Psychedelics</a></li>

<li><a href="Dissociative" title="Dissociative">Dissociatives</a></li>

<li><a href="Deliriant" title="Deliriant">Deliriants</a></li></ul></li>

<li><a href="Hypnotic" title="Hypnotic">Hypnotics</a> / <a href="Sedative" title="Sedative">Sedatives</a></li>

<li><a href="Mood_stabilizer" title="Mood stabilizer">Mood stabilizers</a></li>

<li><a href="Motivation-enhancing_drug" title="Motivation-enhancing drug">Motivation-enhancing drug</a></li>

<li><a href="Neuroprotective" class="mw-redirect" title="Neuroprotective">Neuroprotectives</a></li>

<li><a href="Nootropic" title="Nootropic">Nootropics</a></li>

<li><a href="Neurotoxin" title="Neurotoxin">Neurotoxins</a></li>

<li><a href="Orexigenic" class="mw-redirect" title="Orexigenic">Orexigenics</a></li>

<li><a href="Serenic" title="Serenic">Serenics</a></li>

<li><a href="Stimulant" title="Stimulant">Stimulants</a></li>

<li><a href="Wakefulness-promoting_agent" title="Wakefulness-promoting agent">Wakefulness-promoting agents</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Respiratory_system" title="Respiratory system">respiratory<br>system</a> (<a href="ATC_code_R" title="ATC code R">R</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Decongestant" title="Decongestant">Decongestants</a></li>

<li><a href="Bronchodilator" title="Bronchodilator">Bronchodilators</a></li>

<li><a href="Cough_medicine" class="mw-redirect" title="Cough medicine">Cough medicines</a></li>

<li><a href="H1_antagonist" title="H1 antagonist">H<sub>1</sub> antagonists</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Sense" title="Sense">sensory organs</a> (<a href="ATC_code_S" title="ATC code S">S</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Ophthalmology" title="Ophthalmology">Ophthalmologicals</a></li>

<li><a href="Otology" title="Otology">Otologicals</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">other <a href="Anatomical_Therapeutic_Chemical_Classification_System" title="Anatomical Therapeutic Chemical Classification System">ATC</a> (<a href="ATC_code_V" title="ATC code V">V</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Antidote" title="Antidote">Antidotes</a></li>

<li><a href="Contrast_medium" class="mw-redirect" title="Contrast medium">Contrast media</a></li>

<li><a href="Radiopharmacology" title="Radiopharmacology">Radiopharmaceuticals</a></li>

<li><a href="Dressing_(medicine)" title="Dressing (medicine)">Dressings</a></li>

<li><a href="Senotherapeutics" class="mw-redirect" title="Senotherapeutics">Senotherapeutics</a></li></ul>

</div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div>

<ul><li><span class="noviewer" typeof="mw:File"><span title="Category"></span></span> Drugs</li>

<li>Pharmacological classification systems</li>

<li>ATC codes</li>

<li><span class="noviewer" typeof="mw:File"></span> <a href="Portal%3AMedicine" title="Portal:Medicine">Medicine portal</a></li></ul>

</div></td></tr></tbody></table></div>

<div class="navbox-styles"></div><div role="navigation" class="navbox" aria-labelledby="Antiarrhythmic_agents_(C01B)186" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Antiarrhythmic_agents_(C01B)186" style="font-size:114%;margin:0 4em"> (<a href="ATC_code_C01#C01B" title="ATC code C01">C01B</a>)</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Channel_blocker" title="Channel blocker">Channel blockers</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="class_I(Na+_channel_blockers)442" scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink-fragment" href="#Class_I_agents">class I</a><br>(<a href="Sodium_channel_blocker" title="Sodium channel blocker">Na<sup>+</sup> channel blockers</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">class Ia (<a href="Cardiac_action_potential#Phase_0" title="Cardiac action potential">Phase 0</a>→ and <a href="Cardiac_action_potential#Phase_3" title="Cardiac action potential">Phase 3</a>→)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Ajmaline" title="Ajmaline">Ajmaline</a></li>

<li><a href="Disopyramide" title="Disopyramide">Disopyramide</a></li>

<li><a href="Dihydroquinidine" title="Dihydroquinidine">Hydroquinidine</a></li>

<li><a href="Lorajmine" title="Lorajmine">Lorajmine</a></li>

<li><a href="Prajmaline" title="Prajmaline">Prajmaline</a></li>

<li><a href="Procainamide" title="Procainamide">Procainamide</a><sup>#</sup></li>

<li><a href="Quinidine" title="Quinidine">Quinidine</a><sup>#</sup></li>

<li><a href="Sparteine" title="Sparteine">Sparteine</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">class Ib (<a href="Cardiac_action_potential#Phase_3" title="Cardiac action potential">Phase 3</a>←)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Lidocaine" title="Lidocaine">Lidocaine</a><sup>#</sup></li></ul></li>

<li><i><a href="Enteral" class="mw-redirect" title="Enteral">enteral</a></i>

<ul><li><a href="Aprindine" title="Aprindine">Aprindine</a></li>

<li><a href="Mexiletine" title="Mexiletine">Mexiletine</a></li>

<li><a href="Tocainide" title="Tocainide">Tocainide</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">class Ic (<a href="Cardiac_action_potential#Phase_0" title="Cardiac action potential">Phase 0</a>→)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Encainide" title="Encainide">Encainide</a><sup>‡</sup></li>

<li><a href="Ethacizine" title="Ethacizine">Ethacizine</a></li>

<li><a href="Flecainide" title="Flecainide">Flecainide</a></li>

<li><a href="Indecainide" title="Indecainide">Indecainide</a><sup>‡</sup></li>

<li><a href="Lorcainide" title="Lorcainide">Lorcainide</a></li>

<li><a href="Moracizine" title="Moracizine">Moracizine</a><sup>‡</sup></li>

<li><a href="Propafenone" title="Propafenone">Propafenone</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink-fragment" href="#Class_III_agents">class III</a><br>(<a href="Cardiac_action_potential#Phase_3" title="Cardiac action potential">Phase 3</a>→, <a href="Potassium_channel_blocker" title="Potassium channel blocker">K<sup>+</sup> channel blockers</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Amiodarone" title="Amiodarone">Amiodarone</a></li>

<li><a href="Bretylium" title="Bretylium">Bretylium</a></li>

<li><a href="Bunaftine" title="Bunaftine">Bunaftine</a></li>

<li><a href="Celivarone" title="Celivarone">Celivarone</a><sup>†</sup></li>

<li><a href="Dofetilide" title="Dofetilide">Dofetilide</a></li>

<li><a href="Dronedarone" title="Dronedarone">Dronedarone</a></li>

<li><a href="Ibutilide" title="Ibutilide">Ibutilide</a></li>

<li><a href="Nifekalant" title="Nifekalant">Nifekalant</a></li>

<li><a href="Sotalol" title="Sotalol">Sotalol</a></li>

<li><a href="Tedisamil" title="Tedisamil">Tedisamil</a></li>

<li><a href="Vernakalant" title="Vernakalant">Vernakalant</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink-fragment" href="#Class_IV_agents">class IV</a><br>(<a href="Cardiac_action_potential#Phase_4" title="Cardiac action potential">Phase 4</a>→, <a href="Calcium_channel_blocker" title="Calcium channel blocker">Ca<sup>2+</sup> channel blockers</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Diltiazem" title="Diltiazem">Diltiazem</a></li>

<li><a href="Verapamil" title="Verapamil">Verapamil</a><sup>#</sup></li></ul>

</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Receptor_(biochemistry)" title="Receptor (biochemistry)">Receptor</a> <a href="Agonist" title="Agonist">agonists</a><br>and <a href="Receptor_antagonist" title="Receptor antagonist">antagonists</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink-fragment" href="#Class_II_agents">class II</a><br>(<a href="Cardiac_action_potential#Phase_4" title="Cardiac action potential">Phase 4</a>→, <a href="Beta_blocker" title="Beta blocker">β blockers</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Nadolol" title="Nadolol">Nadolol</a></li>

<li><a href="Pindolol" title="Pindolol">Pindolol</a></li>

<li><a href="Propranolol" title="Propranolol">Propranolol</a></li>

<li><i>cardioselective</i>

<ul><li><a href="Acebutolol" title="Acebutolol">Acebutolol</a></li>

<li><a href="Atenolol" title="Atenolol">Atenolol</a></li>

<li><a href="Esmolol" title="Esmolol">Esmolol</a></li>

<li><a href="Landiolol" title="Landiolol">Landiolol</a></li>

<li><a href="Metoprolol" title="Metoprolol">Metoprolol</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Adenosine_A1_receptor" title="Adenosine A1 receptor">A<sub>1</sub> agonist</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Adenosine" title="Adenosine">Adenosine</a></li>

<li><a href="Benzodiazepine" title="Benzodiazepine">Benzodiazepines</a></li>

<li><a href="Barbiturate" title="Barbiturate">Barbiturates</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Muscarinic_acetylcholine_receptor_M2" title="Muscarinic acetylcholine receptor M2">M<sub>2</sub></a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Muscarinic_antagonist" title="Muscarinic antagonist">muscarinic antagonist</a>: <a href="Atropine" title="Atropine">Atropine</a></li>

<li><a href="Disopyramide" title="Disopyramide">Disopyramide</a></li>

<li><a href="Quinidine" title="Quinidine">Quinidine</a><br><a href="Muscarinic_agonist" title="Muscarinic agonist">muscarinic agonist</a>: <a href="Digoxin" title="Digoxin">Digoxin</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Adrenergic_receptor#.CE.B1_receptors" title="Adrenergic receptor">α receptors</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Amiodarone" title="Amiodarone">Amiodarone</a></li>

<li><a href="Bretylium" title="Bretylium">Bretylium</a></li>

<li><a href="Quinidine" title="Quinidine">Quinidine</a></li>

<li><a href="Verapamil" title="Verapamil">Verapamil</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Ion_transporter" title="Ion transporter">Ion transporters</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Na+/_K+-ATPase54" scope="row" class="navbox-group" style="width:1%"><a href="Na%2B/K%2B-ATPase" class="mw-redirect" title="Na+/K+-ATPase">Na<sup>+</sup>/ K<sup>+</sup>-ATPase</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Digitoxin" title="Digitoxin">Digitoxin</a></li>

<li><a href="Digoxin" title="Digoxin">Digoxin</a></li>

<li><a href="Ouabain" title="Ouabain">Ouabain</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist">

<li><sup>‡</sup><a href="List_of_withdrawn_drugs" title="List of withdrawn drugs">Withdrawn</a> from market</li>

<li><a href="Clinical_trial" title="Clinical trial">Clinical trials</a>:

<ul><li><sup>†</sup><a href="Phases_of_clinical_research#Phase_III" title="Phases of clinical research">Phase III</a></li>

<li><sup>§</sup>Never to phase III</li></ul></li></ul>

</div></div></td></tr></tbody></table></div>

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This article is issued from <a class="external text" title="Last edited on 2025-07-15" href="https://en.wikipedia.org/wiki/?title=Antiarrhythmic_agent&oldid=1300689081">Wikipedia</a>. The text is available under <a class="external text" href="https://creativecommons.org/licenses/by-sa/4.0/deed.en">Creative Commons Attribution-Share Alike 4.0</a> unless otherwise noted. Additional terms may apply for the media files.

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