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Quinidine Increases sinus node

frequency and prolongs PR interval, QRS duration, and

QT intervala (VFc, BrS, SQTS) 600–1600 mg Loading dose:

Start 200 mg every 3 h until effect, max. 3 g in

first 24 h Cardiac: Hypotension, TdPd

Extracardiac: Gastrointestinal disturbances, auditory and visual disturbances, confusion, leukopenia, haemolytic anaemia, thrombocytopenia, anaphylaxis Contraindications: Severe sinus node dysfunction, severe AV or intraventricular conduction disturbances, previous MI, significant SHD, hypotension, LQTS

Ranolazine Decreases sinus node frequency,

prolongs QT

intervala VT (LQTS3) 750–2000 mg Cardiac: Sinus bradycardia, hypotension Extracardiac: Dizziness, nausea, constipation, gastrointestinal disturbance, headache, rash

Contraindications: Severe sinus node dysfunction, severe heart failure, LQTS (other than LQTS3) Precautions: Concomitant treatments associated with QT interval prolongation Sotalol Decreases sinus node frequency,

prolongs QT

intervala VT 160–640 mg (0.5–1.5 mg/kg in

10 min. If necessary, can be repeated after

6 h) See beta-blockers, TdPd

(.2% of patients, close monitoring of QT interval and CrCl)

Contraindications: Severe sinus node dysfunction, severe AV conduction disturbances, severe heart failure with reduced LVEF, significant LVH, CrCl ,30 ml/min, coronary vasospasm, LQTS Precautions: Concomitant treatments associated with QT interval prolongation, hypokalaemia Other considerations: Potassium channel blocker effects require higher dose than beta-blocker effects Verapamil Prolongs PR interval (LV fascicular

tachycardia) 120–480 mg (5–10 mg in slow bolus. If necessary, can be repeated in

30 min) Cardiac: Sinus bradycardia in sinus node dysfunction, AV block, negative inotrope, hypotension Extracardiac: Gastrointestinal disturbances, peripheral oedema, flushing Contraindications: Heart failure with reduced LVEF, severe sinus node dysfunction, and severe AV conduction disturbances, VT of unknown origin, ACS, WPW syndrome Other considerations: Increase the risk of myopathy when used with statins © ESC 2022

ACS, acute coronary syndrome; AF, atrial fibrillation; AV, atrioventricular; BrS, Brugada syndrome; CPVT, catecholaminergic polymorphic ventricular tachycardia; CrCl, creatinine clearance; ECG, electrocardiogram; ERS, early repolarization syndrome; HCM, hypertrophic cardiomyopathy; LQTS, long QT syndrome; LV, left ventricular; LVEF, left ventricular ejection fraction; LVH, left ventricular hypertrophy; MI, myocardial infarction; MVT, monomorphic ventricular tachycardia; PVC, premature ventricular complex; SHD, structural heart disease; SQTS, short QT syndrome; TdP, torsades de pointes; VF, ventricular fibrillation; VT, ventricular tachycardia; WPW, Wolff–Parkinson–White. aPrecaution with concomitant conditions or drugs that prolong QT interval. Should be discontinued if QTc .500 ms. See Figure 13 Algorithm for evaluation before initiation and follow-up of patients requiring drugs associated with QT prolongation. bIf ajmaline not available. cSubacute MI, multifocal ectopic Purkinje-related premature contractions, ERS, idiopathic VF. dProarrhythmic side effects require strong indication in patients without ICD. Downloaded from academic.oup.com/eurheartj/article/43/40/3997/6675633 by guest on 07 October 2026