Classification of Antiarrhythmic Drugs

Many reasons impose classification of the antiarrhythmic drugsAntiarrhythmic drugs (AADs). First, similar to antibiotics, AADs are effective in some arrhythmiasArrhythmias but not in others. Second, AADs represent a very heterogeneous structural and functional group. Third, the currentCurrents available AADs act on sensible molecular and functional targets and have a narrow therapeutic interval (see Chapter 12 ) explaining a high degree of adverse effectsAdverse effects and proarrhythmic risk (Valembois et al. in Cochrane Database Syst Rev, 2019), however different among members of the “class”. This is why Gunther Breithardt said once that “antiarrhythmics are like matches; they must not be left out of the reach of childrenChildren” and Phillipe Coumel quoted referring to “classical” AADs “antiarrhythmics are a poison that sometimes helps”. Moreover, after the CAST study (Trial in N Engl J Med 321:406–41, 1989), which demonstrated increased mortality with the new class I AADs, new molecules, more selective and targeting completely different substrates as compared with classical AADs, were developed imposing new criteria for classification (Dan and Dobrev in IJC Hear Vasc 21:11–15, 2018).