Table 2.

Antiarrhythmic drugs. VT = ventricular tachycardia, VPB = ventricular premature beat, LQTS = long QT syndrome, CPVT = catecholaminergic ventricular tachycardia, BB = Betablocker, AVN = atrio-ventricular node, VF = ventricular fibrillation, TdP = Torsade de pointes tachycardia, LVEF = left ventricular ejection fraction, HFrEF = heart failure with reduced ejection fraction.

Antiarrhythmic drug (Vaughan Williams Class) Dose	Special feature	Indication	Important side effects or contraindications
Ajmaline (IA) i.v. single dose 1 mg/kg till max. 100 mg Infusion: speed max. 10 mg/min; continuous infusion: 10–50 mg/h	short half-life, easy titration	VT, VF, malignant arrhythmias triggered by short coupled VPBs, (Ajmaline-test to unmask Brugada-syndrome)	QRS widening, PQ-prolongation, QT-prolongation, pro-arrhythmic effect (stop therapy in case of QRS widening > 25%, PQ-prolongation > 50%, QTc prolongation > 500 ms)
Quinidine (IA) p.o. sulfate 200–600 mg every 6-12hrs gluconate 324–648 mg every 8-12hrs i.v. total 800 mg, rate 50 mg/min	strong blocker of transient K-efflux	VF, Brugada syndrome, SQTS, VF in acute MI, malignant arrhythmias triggered by short coupled VPBs	syncope, TdP, AV-block, nausea, vomiting, QRS widening, QTc prolongation
Lidocaine (IB) i.v. 1–1,5mg/kg bolus, then 0,5–0,75 mg/kg bolus every 5–10 min, max. dose 3 mg/kg Infusion: 1–4 mg/min	advantage of stronger binding and effect in low pH and membrane potential in case of ischemia triggered VTs	VTs caused by acute myocardial ischemia	proarrhythmic, bradycardia, delirium, psychosis
Mexiletine (IB) p.o. 150–300 mg every 8-12hrs	especially as add-on in inefficiency of amiodarone	VT, LQTS3	heart failure, sinus node dysfunction, AV-block
Flecainide (IC) p.o. 50–200 mg every 12hrs Propafenone (IC) p.o. 150–300 mg every 8hrs	PQ-prolongation, QRS-prolongation	VPBs, VT, flecainide also for CPVT	bradycardia, med. induced Brugada syndrome, monomorphic VTs due to myocardial scar, eventually acute reduction of LVEF in HFrEF
Beta-Blocker (II) Propranolol: i.v. 1–3 mg every 5 min max. 5 mg if necessary repeated after 4hrs Esmolol: i.v. 0,5mg/kg bolus, then 0,05 mg/kg/min Landiolol: i.v. 0,1–0,3mg/kg bolus, then 0,01–0,04 mg/kg/min	cornerstone of VT therapy advantage of non-selective BB is suppression of adrenergic tonus (e.g. propranolol) in case of severely reduced LVEF BB with short half-life (e. g. esmolol, landiolol). reduction in sinus rate, increase of AVN refractoriness ultra-short half-life (3–5 min), advantage of less pronounced neg. inotrope effect and reduced risk of hypotension [9], [36].	VPB, VT, LQTS, CPVT	hypotension, bradycardia, AV-block, bronchospasm
Sotalol (III) p.o. 160 – 320 mg/day	betablocker and class III antiarrhythmic drug	VT, 2nd line drug in ARVC	QT-prolongation, TdP, bradycardia, AV-block, depression
Amiodarone (III) i.v. 150–300 mg bolus; 1 mg/min for 6hrs, then 0,5mg/min for 18 h p.o. 3x200-400 mg/day, if 10 g total dose 200 mg/day	most important emergency antiarrhythmic drug, even more effective, if combined with BB reduction of sinus rate, QRS prolongation, QTc prolongation, increase of AVN-refractoriness	VT, VF	bradycardia, AV-block, QT-prolongation (proarrhythmic effect, if QTc > 500 ms TdP) contraindication: LQTS, TdP, bradycardia induced VTs
Verapamil (IV) i.v. 2,5–5 mg every 15–30 min p.o.: 240–480 mg/day	reduction of sinus rate and AV-conduction, PQ-prolongation	VT, VPBs, fascicular VT	hypotension, edema, aggravation of HFrEF, AV-block, bradycardia
Isuprenaline (other) i.v. 0.5–20 μg/min	cardiac acceleration to suppress ectopic VPBs, enhancement of the inward calcium current to eliminate the transmural voltage gradient	Electrical Storm in Brugada syndrome, early repolarization syndrome and short QT syndrome	hypotension, tachycardia, hypokalemia