Drugs of Choice for Cardiac Arrhythmias

Arrhythmia
(Links point to ECGs)

Drug of Choice
(Non-drug therapy)

Alternatives
(Non-drug therapy)

Atrial fibrillation/flutter

• (Cardioversion)

• Verapamil, diltiazem, or beta-blocker to slow ventricular response

• Digoxin to slow ventricular response

• Class IA, IC drugs for long-term suppression

• Ibutilide for termination

• Low dose amiodarone for prevention

• Dofetilide for prevention

• (RF ablation)

Other supraventricular tachycardias

• Adenosine, verapamil, or diltiazem for termination

• (RF ablation)

• Class II drugs or digoxin for termination

• (Cardioversion or atrial pacing)

• Class IA, IC, II, or IV drugs or digoxin for long-term suppression

PVCs or non-sustained ventricular tachycardia

• No drug therapy for asymptomatic patients

• Class II drugs for symptomatic patients

• (Cardioversion or chest thump is the safest and most effective treatment)

• Lidocaine for acute treatment

• Procainamide, bretylium or amiodarone for acute treatment

• Sotalol, amiodarone, Class IA, IB, II, III can be used for long-term suppression

• (RF ablation or ICD)

• (Defibrillation is treatment of choice)

• Lidocaine to prevent recurrence

• Amiodarone, procainamide or bretylium to prevent recurrence

• (RF ablation or ICD)

• Digibind for life-threatening toxicity

• Lidocaine

• Phenytoin

• Avoid cardioversion except for ventricular fibrillation

• Potassium (if hypokalemic)

• Magnesium sulfate

• Remove causative agents

• Isoproterenol

• Potassium (if hypokalemic)

• (Cardiac pacing)