Table of ContentsView AllTable of ContentsHow Are Heart Arrhythmias Treated?Antiarrhythmic DrugsBeta-BlockersCalcium Channel BlockersAnticoagulantsCardiac GlycosidesOther Treatments
Table of ContentsView All
View All
Table of Contents
How Are Heart Arrhythmias Treated?
Antiarrhythmic Drugs
Beta-Blockers
Calcium Channel Blockers
Anticoagulants
Cardiac Glycosides
Other Treatments
A heart arrhythmia is an irregular heartbeat, which means it can be too quick, slow, or beat with an abnormal rhythm.
Medications play a crucial role in controlling and preventing arrhythmias and ensuring the heart maintains a steady and effective rhythm. Among the most prescribed drugs for this purpose are beta blockers, calcium channel blockers, and a variety of antiarrhythmic agents.
Antiarrhythmic drugs are categorized into four main classes (Class I, II, III, and IV) based on the Vaughan-Williams classification system.
Getty Images / Gorica Poturak
Heart arrhythmiasare treated with various medications to restore normal heart rhythm, control heart rate, and prevent complications. The choice of medication depends on the type of arrhythmia, its severity, and the person’s condition.
Classes of medications used for heart arrhythmias include the following.
Types of ArrhythmiasAtrial fibrillation(most common): A “quivering” or irregular heart rhythm, which can lead to complications such as a stroke.Bradycardia(slow heart rate): A heart rate of less than 60 beats per minute.Tachycardia(fast heart rate): A heart rate greater than 100 beats per minute.Ventricular fibrillation: The most serious abnormal heart rhythm that can lead to sudden cardiac death.Supraventricular tachycardia (SVT): A rapid heart rate originating above the heart’s ventricles that is usually greater than 150 beats per minute.
Types of Arrhythmias
Atrial fibrillation(most common): A “quivering” or irregular heart rhythm, which can lead to complications such as a stroke.Bradycardia(slow heart rate): A heart rate of less than 60 beats per minute.Tachycardia(fast heart rate): A heart rate greater than 100 beats per minute.Ventricular fibrillation: The most serious abnormal heart rhythm that can lead to sudden cardiac death.Supraventricular tachycardia (SVT): A rapid heart rate originating above the heart’s ventricles that is usually greater than 150 beats per minute.
The term “arrhythmia” refers to any change from the heart’s normal electrical impulses.
Sodium Channel Blockers (Class I)
Sodium channel blockers are used to treat ventricular arrhythmia. Class I antiarrhythmics should not be used in people withheart failure.
Examples include:
Side effects of these kinds of drugs include:
Potassium Channel Blockers (Class III)
Side effects of these drugs include:
Beta-Blockers (Class II)
Beta-blockersare classified as Class II under the Vaughan Williams classification system. Beta-blockers are used for several conditions, including but not limited to:
Beta-blockers are more effective at heart rate control than other antiarrhythmic drugs. In other words, they are better at slowing down the heart than changing the electrical impulses.
Examples of beta-blockers include:
Side effects may include:
Calcium Channel Blockers (Class IV)
These drugs cause relaxation and dilation of blood vessels, reducing heart workload and oxygen demand.
CCBs are divided into two main categories: dihydropyridines (DHPs) and non-dihydropyridines (non-DHPs).
Examples of DHPs include:
Non-DHPs include Verelan (verapamil) and Cardizem (diltiazem).
While not used for treating arrhythmias,anticoagulantsprevent blood clots that can form because of certain arrhythmias, such as atrial fibrillation. They are also used in other conditions at risk for a thrombosis (blood clot), deep vein thrombosis, and in people with mechanical heart valves.
Anticoagulants interfere with the clotting cascade, a series of events involving factors that lead to clotting. There are different types of anticoagulants based on their mechanism of action:
Examples of each include
Bleeding is the most common side effect. This can occur in your gastrointestinal tract, nose, and skin (bruising).
For those on warfarin, it is recommended to eat a consistent diet involving a similar amount ofvitamin K-containing foods regularly.
Digoxin is an example of a cardiac glycoside. It may cause some stomach-related side effects, such as nausea or vomiting. Other side effects can include:
Other Treatments for Heart Arrhythmias
Electrophysiology Study (EPS) and Ablation
EPS andablationare used to diagnose and treat arrhythmias, such as recurrent arrhythmias like atrial fibrillation, atrial flutter, and ventricular tachycardia.
Catheters are inserted into the heart to map electrical activity. If an abnormal pathway is found, it can be ablated (destroyed) using radiofrequency energy or cryotherapy.
Implantable Devices
Pacemakersare small devices implanted under the skin to help control abnormal heart rhythms. They send electrical impulses to stimulate the heart to beat at a normal rate.
Pacemakers are typically used to treat bradycardia (slow heart rate) and heart block.
Implantable cardioverter-defibrillators (ICDs)are devices implanted under the skin. They monitor heart rhythms and deliver shocks if a dangerous rhythm is detected to restore normal rhythm. ICDs are used to treat ventricular fibrillation and ventricular tachycardia.
Summary
Heart arrhythmias are managed with medications to restore normal rhythm, control heart rate, and prevent complications. The choice of drugs depends on the type and severity of the arrhythmia.
Commonly used drug classes include beta-blockers (e.g., atenolol, metoprolol) and calcium channel blockers (e.g., diltiazem, verapamil) for atrial fibrillation, flutter, and SVT.
Antiarrhythmics, such as sodium and potassium channel blockers (e.g., quinidine, amiodarone), treat a broader range of arrhythmias, including ventricular tachycardia. Other important medications used include digoxin and anticoagulants (e.g., warfarin) in those with atrial fibrillation who are at high risk of stroke.
The author would like to recognize and thank Norma Ponce, PharmD, for contributing to this article.
21 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Atrial fibrillation medications.Joglar JA, Chung MK, Armbruster AL, et al.2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR.0000000000001193Wołowiec Ł, Grześk G, Osiak J, et al.Beta-blockers in cardiac arrhythmias-clinical pharmacologist’s point of view.Front Pharmacol.2023;13:1043714. doi:10.3389/fphar.2022.1043714DailyMed.Label: verapamil hydrochloride tablet.DailyMed.Label: flecainide acetate tablet.DailyMed.Label: amiodarone hydrochloride tablet.DailyMed.Label: digoxin tablet.DailyMed.Norpace label.DailyMed.Label: Sotalol hydrochloride tablet.DailyMed.Label: dofetilide capsule.DailyMed.Label: Ibutilide fumarate injection, solution.DailyMed.Carvedilol label.The Texas Heart Institute.Antiarrhythmics.DailyMed.Label: amlodipine besylate tablet.National Blood Clot Alliance.What are the potential side effects of anticoagulants?UpToDate.Patient education: warfarin (beyond the basics).American Heart Association.Arrhythmia.American Heart Association.Surgical procedures for atrial fibrillation.American Heart Association.Non-surgical procedures for atrial fibrillation.MedlinePlus.Heart pacemaker.American Heart Association.Implantable cardioverter defibrillator (ICD).
21 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Atrial fibrillation medications.Joglar JA, Chung MK, Armbruster AL, et al.2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR.0000000000001193Wołowiec Ł, Grześk G, Osiak J, et al.Beta-blockers in cardiac arrhythmias-clinical pharmacologist’s point of view.Front Pharmacol.2023;13:1043714. doi:10.3389/fphar.2022.1043714DailyMed.Label: verapamil hydrochloride tablet.DailyMed.Label: flecainide acetate tablet.DailyMed.Label: amiodarone hydrochloride tablet.DailyMed.Label: digoxin tablet.DailyMed.Norpace label.DailyMed.Label: Sotalol hydrochloride tablet.DailyMed.Label: dofetilide capsule.DailyMed.Label: Ibutilide fumarate injection, solution.DailyMed.Carvedilol label.The Texas Heart Institute.Antiarrhythmics.DailyMed.Label: amlodipine besylate tablet.National Blood Clot Alliance.What are the potential side effects of anticoagulants?UpToDate.Patient education: warfarin (beyond the basics).American Heart Association.Arrhythmia.American Heart Association.Surgical procedures for atrial fibrillation.American Heart Association.Non-surgical procedures for atrial fibrillation.MedlinePlus.Heart pacemaker.American Heart Association.Implantable cardioverter defibrillator (ICD).
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Heart Association.Atrial fibrillation medications.Joglar JA, Chung MK, Armbruster AL, et al.2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR.0000000000001193Wołowiec Ł, Grześk G, Osiak J, et al.Beta-blockers in cardiac arrhythmias-clinical pharmacologist’s point of view.Front Pharmacol.2023;13:1043714. doi:10.3389/fphar.2022.1043714DailyMed.Label: verapamil hydrochloride tablet.DailyMed.Label: flecainide acetate tablet.DailyMed.Label: amiodarone hydrochloride tablet.DailyMed.Label: digoxin tablet.DailyMed.Norpace label.DailyMed.Label: Sotalol hydrochloride tablet.DailyMed.Label: dofetilide capsule.DailyMed.Label: Ibutilide fumarate injection, solution.DailyMed.Carvedilol label.The Texas Heart Institute.Antiarrhythmics.DailyMed.Label: amlodipine besylate tablet.National Blood Clot Alliance.What are the potential side effects of anticoagulants?UpToDate.Patient education: warfarin (beyond the basics).American Heart Association.Arrhythmia.American Heart Association.Surgical procedures for atrial fibrillation.American Heart Association.Non-surgical procedures for atrial fibrillation.MedlinePlus.Heart pacemaker.American Heart Association.Implantable cardioverter defibrillator (ICD).
American Heart Association.Atrial fibrillation medications.
Joglar JA, Chung MK, Armbruster AL, et al.2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR.0000000000001193
Wołowiec Ł, Grześk G, Osiak J, et al.Beta-blockers in cardiac arrhythmias-clinical pharmacologist’s point of view.Front Pharmacol.2023;13:1043714. doi:10.3389/fphar.2022.1043714
DailyMed.Label: verapamil hydrochloride tablet.
DailyMed.Label: flecainide acetate tablet.
DailyMed.Label: amiodarone hydrochloride tablet.
DailyMed.Label: digoxin tablet.
DailyMed.Norpace label.
DailyMed.Label: Sotalol hydrochloride tablet.
DailyMed.Label: dofetilide capsule.
DailyMed.Label: Ibutilide fumarate injection, solution.
DailyMed.Carvedilol label.
The Texas Heart Institute.Antiarrhythmics.
DailyMed.Label: amlodipine besylate tablet.
National Blood Clot Alliance.What are the potential side effects of anticoagulants?
UpToDate.Patient education: warfarin (beyond the basics).
American Heart Association.Arrhythmia.
American Heart Association.Surgical procedures for atrial fibrillation.
American Heart Association.Non-surgical procedures for atrial fibrillation.
MedlinePlus.Heart pacemaker.
American Heart Association.Implantable cardioverter defibrillator (ICD).
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