Ike Husen1, Dwi Indria Anggraini2

1Depart.Of Pharmacology & Therapy, Medical Faculty , Padjadjaran University

2Depart. Of Pharmacology & Therapy, Medical Faculty , Lampung University
Arrhythmia :
asymptomatic life threatening

Antiarrhythmia 2 goals :
Termination of an ongoing Arrhythmia
Prevention of a recurrence

Control arrhythmia
Proarrhytmic effect
 Cardiac cycle: automaticity Rhythmic AP

SA node AV node HIS-purkinje

system
 Action Potential

1
2

0 mV

0 3

-85 mV
eff refractory period

0 : depolarization 2 : Plateau phase

1 : partial repolarization 3 : repolarization
Mechanisms of AAD actions :

suppressing the initiating mechanism

slow automaticity
1. phase 4 slope -blockers
2. threshold block of Na+, Ca++
3. max. diastolic potential adenosine
4. AP duration block of K+

altering the re-entrant circuit

Na channel blocker slow phase 0 depol

excitability
conductivity

Use-dependence tachycardia
 -blocker slow phase 4 depol

automaticity

HR & contractility AV conduction time

K channel blockers prolong phase 3

AP duration
eff. refractory period
AMIODARONE

Class I, II, III & IV action mainly class III

HR & PR interval
 Pacemakers
Surgical implantation of electrical leads attached to a
pulse generator
Over 175,000 implanted per year
1) Leads are inserted via subclavicle vein and advanced to the
chambers on the vena cava (right) side of the heart
2) Two leads used, one for right atrium, other for right ventricle
3) Pulse generator containing microcircuitry and battery are
attached to leads and placed into a pocket under the skin
near the clavicle
4) Pulse generator sends signal down leads in programmed
sequence to contract atria, then ventricles
Pulse generator can sense electrical activity generated
by the heart and only deliver electrical impulses when
needed.
Pacemakers can only speed up a heart experiencing
bradycardia, they cannot alter a condition of
tachycardia
Implantation of Pacemaker