A variety of arrhythmias may be caused or worsened by many widely used medications from numerous therapeutic classes including antiarrhythmatic agents, antimicrobial drugs, psychotropic medications, methadone, neurological agents, anticancer drugs and others, according to a scientific statement from the American Heart Association published Sept. 15 in Circulation.

James E. Tisdale, PharmD, et al., sought to review drugs that cause or exacerbate arrhythmias, consider risk factors, discuss monitoring strategies, describe methods for prevention and risk reduction, and review treatment options.

In the statement, the authors discuss drug-induced bradyarrhythmias, drug-induced supraventricular arrhythmias (atrial fibrillation and atrial flutter, atrial tachycardia, and atrioventricular nodal reentrant tachycardia) and drug-induced ventricular arrhythmias (monomorphic ventricular tachycardia, Brugada syndrome, torsades de pointes and QT interval shortening).

Risk factors are well defined for some drug-induced arrhythmias, but the authors highlight the importance of modifying risk factors when possible for prevention and risk reduction. "In patients with nonmodifiable risk factors who require a potentially arrhythmia-inducing drug, enhanced electrocardiographic and other monitoring strategies may be beneficial for early detection and treatment," write the authors.

"Much remains unknown about the mechanisms of arrhythmias associated with specific drugs," according to the statement. "Further research is needed to better define the overall incidence of specific drug-induced arrhythmias, the underlying mechanisms, and the optimal methods to reduce risk and to increase awareness among clinicians and patients. Consideration of the possibility that a patient’s arrhythmia could be drug-induced is important."

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Atrial Flutter, Torsades de Pointes, Tachycardia, Atrioventricular Nodal Reentry, Bradycardia, Atrial Fibrillation, Incidence, American Heart Association, Risk Factors, Methadone, Brugada Syndrome, Tachycardia, Tachycardia, Supraventricular, Electrocardiography, Anti-Infective Agents, Antineoplastic Agents

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