2.3 Anti-arrhythmic drugs

General guidance

For NHS Dudley Atrial Fibrilation (AF) Primary Care Diagnosis and Management Pathway click here

• Management of arrhythmia requires precise diagnosis of the type of arrhythmia, and electrocardiography is essential.
• Spontaneous ectopic beats rarely require treatment other than reassurance. If they are particularly troublesome beta-blockers may be useful.
• In atrial fibrillation ventricular rate can usually be controlled with digoxin. If this is insufficient at rest or during exercise a beta-blocker or verapamil may be added. Anticoagulation is indicated especially in valvular heart disease. Aspirin is less effective then warfarin but may be appropriate if there are no other risk factors for stroke.
• The concomitant use of verapamil and digoxin should be avoided due to the risk of a serious drug-drug interaction.
• For other arrhythmia seek specialist advice.

Recommended drugs

Amiodarone £

Flecainide £

Verapamil SR 240 ££

Diltiazem brand (Viazem XL/Zemtard XL once daily or Angitil SR twice daily) ££

Dronedarone (initiated by consultant only in line with NICE Guidance see here) £££

Mexiletine (not to be prescribed in primary care. Mexiletine should be prescribed and dispensed in hospital only)

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low