. 2025 Mar 30;27(8):euaf076. doi: 10.1093/europace/euaf076

Table 10.

Pro-arrhythmia risk and typical pro-arrhythmia forms of different AADs

Class	Drug	Risk	Type of pro-arrhythmia
0	Ivabradine	Low	Bradycardia, AV block, AF
Ia	Quinidine	High	TdP
	Procainamide	Moderate	AV block, monomorphic VT^a, TdP
	Disopyramide	Low	Bradycardia
Ib	Mexiletine/lidocaine	Low	Bradycardia, AV block
Ic	Flecainide	Moderate	AFL^b, monomorphic VT^a, bradycardia^c
Ic	Propafenone	Moderate	AFL^b, monomorphic VT^a, Bradycardia^c
Id	Ranolazine	Low	QT prolongation
IIa	β-Blockers	Low	Bradycardia, AV block
IIb	Isoprenaline	Low	Sinus tachycardia, PACs, PVCs, VT
IIc	Atropine	Low	Sinus tachycardia, paradoxical AV block^d
IId	Digoxin/digitoxin	Moderate	AV block, junctional tachycardia, polymorphic VT, AT with AV block
IIe	Adenosine	Moderate	Transient sinus bradycardia and AV block, AF, PACs, PVCs
III	Amiodarone	Low	Bradycardia, AFL^b
	Dronedarone	Low^e	Bradycardia
	Dofetilide	High	TdP
	Ibutilide	High	TdP
	Sotalol	High	TdP, bradycardia
	Vernakalant	Low	Sinus bradycardia, NSVT
IV	Verapamil	Low	Bradycardia, AV block
IV	Diltiazem	Low	Bradycardia, AV block

Abbreviations: AF, atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; AV, atrioventricular; NSVT, non-sustained VT; PAC, premature atrial contraction; PVC, premature ventricular contraction; TdP, torsades de pointes; VT, ventricular tachycardia.

^aIn patients with structural heart disease.

^bIn patients with AF.

^cIn patients with sinus node dysfunction or AV conduction disorders.

^dWorsening of AV block on the ECG, such as a progression from second-degree AV block to AV block as atropine increases the sinus rate.

^eHigh when combined with digitalis, as dronedarone reduces the renal excretion of digitalis, amplifying its associated risks. The combination may also increase the likelihood of AV block and other pro-arrhythmic effects.