Risk may include torsades de pointes, development of heart failure, unwanted effects on heart rate, and organ damage or dysfunction.

   Benefits may include the potential for improved quality of life and improved long-term outcomes.

PATHOPHYSIOLOGY

With use of chronic antiarrhythmic medications, consider the following:

• Unique patient characteristics (presence of myocardial ischemia, heart failure, LVH, congenital long QT, etc).

• Drug interactions, known or theoretical.

• Electrolytes, specifically potassium and magnesium.

• Renal function.

• Adverse reactions including toxicities or intolerances.

• Risk of proarrhythmias (prolonged QT, TdP, bradycardia, heart block, wide complex tachycardia, etc).

MANAGEMENT/FOLLOW-UP AND LONG-TERM COMPLICATIONS

Clinical Considerations for Management

• Each class of drugs should be monitored according to the prescribing information.

• Patient encounter for monitoring should always include:

   Patient report of arrhythmia symptoms

   Medication adherence screening

   Drug interaction assessment and education

   Adverse drug reaction screening

   Completion of objective testing

   Consideration of strategy for rate control and stroke prophylaxis as indicated

   Verbal and written patient education

• Defining protocols to guide monitoring allows for improved compliance with adhering to requirements.

   Example protocols attached (Tables 33-1 and 33-2).

TABLE 33-1 Example Clinical Protocols for Monitoring Long-Term Antiarrhythmic Therapy³,⁴,⁵

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