Table 4.
Typical indications and contraindications of major AADs
| Modified VW class | AAD | Main indications | Not to be used/main contraindication |
|---|---|---|---|
| 0 | Ivabradine | Inappropriate sinus tachycardia | AF termination |
| Ia | Ajmaline | AF (pre-excitation) termination MVT (no significant SHD) termination |
BrS, HFrEF |
| Quinidine | PVT (channelopathies) prevention | Long QT | |
| Procainamide | MVT (SHD) termination | HFrEF | |
| Disopyramide | AF (vagotonic) prevention | HFrEF | |
| Ib | Lidocaine | PVT/VF (ischaemia) termination | Bradycardia |
| Mexiletine | TdP (LQTS 3) prevention | Bradycardia | |
| Phenytoin | JET (digitalis toxicity) termination | Bradycardia | |
| Ic | Flecainide/Propafenone | AF (idiopathic) prevention/termination WPW syndrome |
BrS, SHD |
| Antazoline | AF (idiopathic) termination | Bradycardia, SHD | |
| Pilsicainide | AF (idiopathic) termination | SHD | |
| Id | Ranolazine | AF prevention/termination | Long QT except LQT3 |
| IIa | β1-blockers (e.g. bisoprolol, metoprolol) | AF/AFL rate control VT/PVCs (idiopathic) |
Bradycardia |
| β1- + β2-blockers (e.g. nadolol, propranolol) |
TdP (LQTS 1 and 2) prevention CPVT |
Bradycardia | |
| IIb | Isoprenaline | TdP (acquired LQTS) PVT (BrS) |
CPVT |
| IIc | Atropine | Sinus bradycardia | Inappropriate sinus tachycardia |
| IId | Digoxin | AF/AFL rate control | Amyloidosis |
| IIe | Adenosine | PSVT termination | Asthma/COPD |
| III | Amiodarone | AF/AFL (HFrEF) prevention/termination MVT (SHD) prevention/termination |
Bradycardia |
| Dronedarone | AF/AFL (SHD) prevention | Permanent AF, HFrEF | |
| Dofetilide | AF/AFL (HFrEF) prevention | Long QT | |
| Ibutilide | AFL termination | Long QT | |
| Sotalol | MVT (SHD) prevention | CKD, hypokalaemia, hypomagnesaemia or bradycardia | |
| Vernakalant | AF (≤7 d) termination | Aortic stenosis, NYHA III/IV | |
| IV | Verapamil/ Diltiazem |
AF/AFL rate control VT (fascicular) prevention/termination |
MVT (SHD), HFrEF |
Conditions for indications and contraindications are stated in brackets.
Abbreviations: AADs, anti-arrhythmic drugs; AF, atrial fibrillation; AFL, atrial flutter; BrS, Brugada syndrome; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CPVT, catecholaminergic polymorphic ventricular tachycardia; HFrEF, heart failure with reduced ejection fraction; JET, junctional ectopic tachycardia; LQTS, long QT syndrome; LVEF, left ventricular ejection fraction; MVT, monomorphic VT; PVC, premature ventricular contraction; PVT, polymorphic ventricular tachycardia; RVOT, right ventricular outflow tract; SHD, structural heart disease; TdP, torsades de pointes; VF, ventricular fibrillation; VT, ventricular tachycardia; WPW, Wolff–Parkinson–White.