Which medications in the drug class Antiarrhythmic agents are used in the treatment of Pediatric Atrial Flutter?

Updated: Feb 04, 2019
  • Author: M Silvana Horenstein, MD; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Answer

Antiarrhythmic agents

These agents alter the electrophysiologic mechanisms responsible for arrhythmia.

Digoxin (Lanoxin)

Digoxin is a cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. It acts directly on cardiac muscle, increasing myocardial systolic contractions. Its indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

Procainamide

Procainamide is a class IA antiarrhythmic used for premature ventricular contractions (PVCs). It increases the refractory period of the atria and ventricles. Myocardiac excitability is reduced by increase in threshold for excitation and inhibition of ectopic pacemaker activity.

Propafenone (Rythmol, Rythmol SR)

Propafenone treats life-threatening arrhythmias. It may work by reducing spontaneous automaticity and prolonging the refractory period.

Amiodarone (Cordarone, Pacerone)

Amiodarone may inhibit AV conduction and sinus node function. It prolongs the action potential and refractory period in myocardium and inhibits adrenergic stimulation. Before administration, control ventricular rate and congestive heart failure (if present) with digoxin.

Diltiazem (Cardizem, Tiazac, Dilacor XR)

Diltiazem is an AV nodal blocking agent. It is administered IV temporarily (ie, < 24 h) until definitive treatment can be initiated.

Flecainide (Tambocor)

This agent treats life-threatening ventricular arrhythmias. It causes a prolongation of refractory periods and decreases action potential without affecting duration. Flecainide blocks sodium channels, producing a dose-related decrease in intracardiac conduction in all parts of the heart with greatest effect on the His-Purkinje system (H-V conduction). Effects on AV nodal conduction time and intra-atrial conduction times, although present, are less pronounced than on ventricular conduction velocity.

Sotalol (Betapace, Betapace AF, Sorine)

Sotalol is a class III antiarrhythmic agent that blocks potassium channels, prolongs action potential duration, and lengthens the QT interval. It is a non–cardiac selective beta-adrenergic blocker.

Ibutilide (Corvert)

This newer class III antiarrhythmic agent may work by increasing action potential duration, thereby changing atrial cycle length variability. Mean time to conversion is 30 minutes. Two-thirds of patients who convert are in sinus rhythm at 24 hours. Ventricular arrhythmias may occur, mostly PVCs; torsade de pointes is a rare complication.

Dofetilide (Tikosyn)

Recently approved by FDA for maintenance of sinus rhythm, dofetilide increases monophasic action potential duration, primarily because of delayed repolarization. It terminates induced reentrant tachyarrhythmias (eg, atrial fibrillation/flutter, ventricular tachycardia) and prevents their reinduction. It does not affect cardiac output, cardiac index, stroke volume index, or systemic vascular resistance in patients with ventricular tachycardia, mild-to-moderate CHF, angina, and either normal or reduced LVEF. There is no evidence of a negative inotropic effect.

Dronedarone (Multaq)

Dronedarone is a benzofuran derivative indicated to reduce the risk of cardiovascular hospitalization in patients with paroxysmal or persistent atrial fibrillation (AF) or atrial flutter (AFL), with a recent episode of AF/AFL. It is not effective in patients with permanent atrial fibrillation. It may cause bradycardia and QT prolongation. Dronedarone is contraindicated in patients with NYHA class IV heart failure or NYHA class II and class III heart failure who had a recent decompensation. Safety and efficacy of this drug have not been confirmed in patients younger than 18 years.


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