Future of Antiarrhythmic Drugs: Essential Roles in 2025 and Beyond (Joint Session)-Future of Antiarrhythmic Drugs: Essential Roles in 2025 and Beyond (Joint Session)

Video Transcription

Video Summary

The presentation focuses on the classification and clinical use of antiarrhythmic drugs. Initially, the historical Vaughn-Williams classification, which dates back to the 1980s, is discussed, highlighting its outdated nature as it fails to account for multi-class pharmacological effects, metabolite impact, or therapeutic efficacy. The Sicilian Gambit system, introduced in the early 1990s, offers a more nuanced, receptor and channel-based classification. Despite its comprehensiveness, it is considered impractical for regular clinical use due to its complexity. A more recent modernized classification by Lee et al., proposed in 2018, retains some simplicity of Vaughn-Williams' system but incorporates additional classes for future developments.<br /><br />Despite advancements in ablation and device treatments, the stagnancy in antiarrhythmic drug development since 2009 is emphasized, largely due to regulatory demands for substantial efficacy and safety evidence, making trials costly and expansive. Yet, antiarrhythmics remain essential due to candidate limitation for procedures and residual arrhythmias post-ablation.<br /><br />The session also delves into specialized contexts, like heart failure, where drugs like amiodarone are suggested, but with caution for their extracardiac toxicity. The audience is informed on genetic, age, and metabolic considerations when using and combining these drugs, noting specific combos to avoid. Discussion spans issues like consistent QT monitoring in chronic usage and the potential of new delivery methods, such as intranasal administration, to enhance efficacy and safety.<br /><br />Concluding, the importance of a holistic approach using tools like the Atrial Fibrillation Better Care (ABC) pathway is stressed to address arrhythmia challenges beyond mere drug classifications.

Keywords

antiarrhythmic drugs

Vaughn-Williams classification

Sicilian Gambit system

Lee classification

drug development

amiodarone toxicity

QT monitoring

intranasal administration

Atrial Fibrillation Better Care

arrhythmia management