2.3 Anti-arrhythmic drugs

Management of arrhythmia, apart from the treatment associated with heart failure, requires precise diagnosis of the type of

arrhythmia and electrocardiography is essential.

2.3.2 Drugs for arrhythmias

In the management of arrhythmias, beta-blockers should also be considered.

Supraventricular arrhythmias

RED Adenosine injection 6mg/2mL

Digoxin see section 2.1.1

Verapamil see section 2.6.2

Dronedarone

Appraised by NICE in TA197 (August 2010, updated December 2012)as follows:

Before starting treatment with dronedarone, prescribers should perform liver function tests. Tests should be

repeated monthly for six months, at months 9 and 12, and periodically thereafter. Prescribers should

stop treatment with dronedarone in patients with raised levels of the liver enzyme alanine aminotransferase

(more than three times above the upper limit of normal).

Appropriate investigation and close observation of patients should continue until the enzyme levels return to

normal.

MHRA Drug Alert (October 2011) advises of new evidence of cardiovascular, hepatic and pulmonary risk associated

with use of dronedarone, such that regular monitoring of cardiac, liver and renal function is recommended during

treatment and that patients should be reviewed at their next routine appointment to ensure that they remain

eligible for dronedarone treatment according to the revised prescribing information.

AMBER Dronedarone tablets f/c 400mg see Shared Care Guidance

Shared care

Supraventricular and ventricular arrhythmias

AMBER Amiodarone tablets 100mg, 200mg see Shared Care Guidance

Shared care

RED Amiodarone

injection 150mg/3mL

pre-filled syringe 300mg in 10mL

AMBER Flecainide tablets 100mg

RED Flecainide injection 150mg/15mL

Ventricular arrhythmias
RED Lidocaine / lignocaine
Min-I-Jet® 2% (20mg/mL) (5mL)
Infusion 0.1% (1mg/mL) and 0.2% (2mg/mL) in glucose intravenous infusion 5% (500mL containers)

Ventricular arrhythmia

AMBER Propafenone tablets 150mg, 300mg [Specialist initiation]

Reduction of left ventricular outflow tract gradient [unlicensed use]

AMBER Dispoyramide 100mg capsules

Specialist initiation, for use in patients with hypertrophic obstructive cardiomyopathy in cases where beta-blockers/

calcium-channel blockers are ineffective.

Symptomatic obstructive hypertophic cardiomyopathy

NICE TA913 Mavacamten is recommended as an option for treating symptomatic obstructive hypertrophic

cardiomyopathy in adults who have a New York Heart Association class of 2 to 3.

It is recommended only if:

> it is an add-on to individually optimised standard care that includes beta‑blockers,

non-dihydropyridine calcium-channel blockers or disopyramide, unless these are contraindicated,

and

> the company provides it according to the commercial arrangement.

RED Mavacamten 2.5mg capsules (Camzyos®) NHS England Commissioned

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