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Page 97
Volume 08
Clinical Pharmacology & Biopharmaceutics
ISSN: 2167-065X
Pharmacology 2019
World Heart Congress 2019
August 19-20, 2019
JOINT EVENT
conferenceseries
.com
August 19-20, 2019 Vienna, Austria
&
7
th
World Heart Congress
24
th
World Congress on
Pharmacology
Antiarrhythmic drugs – an updated classification after 50 years
Ming Lei
University of Oxford, UK
I
n the late 1960s VaughanWilliams introduced a novel classification of antiarrhythmic drugs. This scheme since has
been widely used around the world and has prompted the development of new drugs with major clinical impact.
Yet fifty years later, arrhythmic diseases still remain a major public health issue. Both scientific investigation and
clinical practice directed at these fall behind advances in other cardiac and medical areas. These problems together
have resulted in a lack of comprehensive yet clear conceptual classification of identified targets and their relationship
to each of the wide range of known arrhythmic mechanisms. Repeated attempts, including that by a working group
of the European Society of Cardiology in 1991 at such a clarification met only limited success.
Our recent focus article published in
Circulation
(2018;138:1879–1896) now bridges these conceptual gaps and
culminates in a modernized drug classification collating findings made over the subsequent five decades. These
compiled and organized studies of different molecular drug targets, their action mechanisms, and consequent
clinical effects, areas in which the authors have themselves contributed, whether as experimentalists or clinicians. It
augments Vaughan Williams’s original framework covering the actions of sodium, potassium and calcium ions and
autonomic nervous effects on these (Class I-IV). The novel categories introduced now bear on altered heart rates
(Class 0), mechanical stretch (Class V); intercellular electrical communication (Class IV) and longer term structural
change (Class VII). The scheme also proceeds to draw attention to
multiple drug targets and actions and possible
adverse, even pro-arrhythmic, effects.
This revised Oxford classification will therefore clarify a rational clinical use of
existing
available anti-arrhythmic
drugs in relationship to their particular
mechanisms of action. It will aid identification and development of novel drugs
relating their
future clinical applications to their molecular mechanisms of action.
Supported by BHF, Wellcome Trust and MRC
Clin Pharmacol Biopharm, Volume 08