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Table 8 Anti-arrhythmic drugs (acute and chronic treatment) Anti-arrhythmic drug Effects on ECG Indications (specific indication) Oral dose per day (i.v. dose) Side effects Contraindications, precautions, other considerations Amiodarone Decreases sinus node frequency, prolongs QT intervala PVC, VT, VF 200–400 mg Loading dose: 600–1200 mg/ 24 h 8–10 days. (Loading dose: 5 mg/kg in 20 min–2 h, 2–3 times in 24 h, then 600–1200 mg/ 24 h 8–10 days) Cardiac: Bradycardia, TdP (infrequent) Extracardiac: Photosensitivity, corneal deposits, hypothyroidism, hyperthyroidism, pulmonary toxicity, hepatotoxicity, polyneuropathy, skin discoloration Precautions: Sinus node dysfunction, severe AV conduction disturbances, hyperthyroidism Other considerations: Can be used in patients with heart failure. Increases the risk of myopathy when used with statins Adenosine Transitory AV block Regular wide complex tachycardia of unknown origin (outflow tract VT) No oral use (6–18 mg bolus) Chest pain, flushing, bronchoconstriction Contraindications: Severe asthma, pre-excited AF Other considerations: Antagonist: theophylline Ajmaline Prolongs QRS duration and QT intervala VT (unmasking BrS ECG) No oral use (1 mg/kg over 5–10 min (maximum dose 100 mg) or 1 mg/kg at 10 mg/min) Cardiac: VF (rare in suspected BrS), occasional TdP, negative inotrope Extracardiac: Cholestatic jaundice, headache, nausea, thrombocytopenia Contraindications: BrS ECG type I, QT prolongation Beta-blocker Decreases sinus node frequency, prolongs PR interval, shortens QT interval PVC, VT (LQTS, CPVT) Various (various) Cardiac: Bradycardia, AV block, hypotension, negative inotrope Extracardiac: Fatigue, bronchospasm, sexual disturbances, depression, cold extremities Contraindications: Severe sinus node dysfunction, severe AV conduction disturbances, decompensated heart failure, coronary vasospasm, severe asthma, BrS Landiolol (Ultra-short acting β1-selective blocker) See beta-blocker VT, electrical storm No oral use 100 μg/kg bolus in 1 min, infusion 10–40 μg/kg/min (max 80 μg/kg/ min; max 24 h total dose 57.6 mg/kg/day) See beta-blocker Contraindications: See beta-blocker. Bradycardia, hypotension Other considerations: Limited experience with its use beyond 24 h Nadolol (Non-selective β1β2 blocker) See beta-blocker PVC, VT (LQTS, CPVT) 40–120 mg See beta-blocker Contraindications: See beta-blocker Other considerations: Plasma half-life 20–24 h Propranolol (Non-selective β1β2 blocker) See beta-blocker PVC, VT (electrical storm, LQTS, CPVT) 80–320 mg (160 mg/24 h) See beta-blocker Contraindications: See beta-blocker Disopyramide Increases sinus node frequency and prolongs PR interval, QRS duration, and QT intervala PVC, VT 250–750 mg Cardiac: Negative inotrope, AV block, pro-arrhythmia (MVT, occasional TdP) Contraindications: Severe sinus node dysfunction, severe AV conduction disturbances, severe intraventricular Continued Downloaded from academic.oup.com/eurheartj/article/43/40/3997/6675633 by guest on 07 October 2026