Table 2

Examples of available therapies for acquired cardiac arrhythmias*

ArrhythmiasMechanisms (initiation/perpetuation)Pharmacological therapiesRationalNon-pharmacological treatments
Microcircuits (re-entries) or triggered activities (EADs/DADs)Flecainide, adenosine, β-ADR blockers
Vagal maneuvers
Calcium antagonists (verapamil), Amiodarone, ACE inhibitors, angiotensin receptor blockers, anti-inflammatory drugs, antioxydants,
T-type Ca blockers (mibefradil), ranolazine
Control of refractoriness, prevention of re0entries (AA)
Negative chronotropy
Prevention of triggered activities
Complete guidance in ref.34
Prevention of remodelling, atrial fibrosis, inflammation and oxidative stress
Therapies under evaluation (ie, targeting atrial-specific currents)
DC cardioversion
Radiofrequency catheter ablation
Abnormal automaticity (atria, AV node, vessels)Class Ic/class III AA, β-ADR blockers, Calcium antagonistsRadiofrequency catheter ablation
Triggered activities (EADs/DADs)
± re-entries
K+/Mg-sulfate infusion (TdP), Calcium antagonists,
Amiodarone, lidocaine, mexiletine (VT),
Reduction of triggered activities
Control of refractoriness (repolarisation acceleration) and/or conduction (AA)
ICDs (AA reduce number of therapies delivered by ICDs)
Wide range of VTs from PVCs in normal subjects to SCD in patients with structural heart diseases define the appropriate treatmentComplete guidance in ref.35ICDs
  • *The list is not exhaustive but rather illustrates main categories. The causes of arrhythmias are diverse and combined: structural remodelling, ion channel dysfunctions, abnormal calcium handling, conduction disturbances, autonomic changes.

  • AA, anti-arrhythmic agents; ADR, adrenoceptor; AF, atrial fibrillation/flutter; AT, atrial tachycardia; AVNRT, AV nodal (re-entrant) tachycardia; Ca, calcium; CDPVT, catecholamine-dependent polymorphic ventricular tachycardia; DAD, delayed afterdepolarisations; DC, direct current; EAD, early afterdepolarisations; HF, heart failure; Hy, hypertrophy; ICDs, implantable cardioverter defibrillators; LQTS, long QT syndrome; PVCs, premature ventricular contractions; SCD, sudden cardiac death; TdP, Torsade de Pointes; VF, ventricular fibrillation; VT, ventricular tachycardia.