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Catheter ablation has transformed the treatment for fast-pulse arrhythmias largely due to technological advances in the field such that many patients can have a reasonable expectation of a cure. Perhaps due to a focus on procedural advances in this period, advances in drug treatments have floundered.
Drugs for the treatment arrhythmias
Drugs to treat fast palpitations have not changed significantly for 30 years. Broadly, they can be classified into 4 categories: Class I drugs which block sodium ion channels such as flecainide, propafenone and disopyramide; class II drugs called beta blockers, for example, bisoprolol, metoprolol and atenolol; class III drugs like amiodarone, which have multiple mechanisms including blockade of potassium ion channels; and finally class IV drugs like verapamil and diltiazem which block calcium ion channels.
No drugs are without side effects or risk. If pharmacological options are to be considered, the drug of choice will depend on the type of arrhythmia being treated as well as other co-existing medical problems. Tolerance and efficacy to any given drug varies significantly between patients and sometimes patients may have to try a number of drugs in succession before settling on one or more. Depending on the arrhythmia being treated, drugs may be used in combination with a catheter ablation procedure to achieve the best result. At LHRG, the therapeutic approach is tailored to deliver invidualised patient care.
There are, to date, no effective oral drug treatments for patients who suffer from slow-pulse heart rhythm disorders for which pacemaker implantation is usually very effective treatment.