Professors Ming Lei and Derek Terrar (Oxford University), Christopher Huang (University of Cambridge), and Lin Wu (Beijing University Hospital) have further developed their 2018 Oxford modernized antiarrhythmic drug (AAD) classification into a practical, more clinically useful, framework in a newly published (2025) article in Heart Rhythm, the official journal of the Heart Rhythm Society (USA) (Heart Rhythm. 2025 Apr 3:S1547-5271). This evolution in AAD classification represents a major step to advance harmonization of therapeutic strategies and drug development across global healthcare systems. The Modernized Oxford AAD classification is poised to become the standard reference in clinical cardiology for managing cardiac arrhythmias.
Cardiac arrhythmias pose a serious global health challenge. The commonest sustained arrhythmia atrial fibrillation (AF) affects 1–2% of the worldwide population. Antiarrhythmic drugs (AADs) remain central to their pharmacotherapeutic management.
The major approach to advancing cardiac arrhythmia management has been recognized in international clinical guidelines for AAD management, in the latest Clinical Consensus Statement from the Task Force of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC). A panel of internationally recognized cardiology experts highlighted and adopted the modernized 2018 Oxford classification as an essential improvement on the classic VW system.
The modernized Oxford AAD classification has been as the most comprehensive and clinically relevant revision of the VW system to date. The updated scheme systematizes a broad range of drug classes and subclasses, placing them within two overarching categories: regulatory-approved, clinically used AADs (Classes 0, I–IV, and VII) and investigational new drugs under development (INDs; Classes V and VI). The former includes existing off-label formulations (e.g ivabradine and ranolazine in Classes 0 and Id respectively).
References:
Lei M, Wu L, Terrar DA, Huang CL. Modernized Classification of Cardiac Antiarrhythmic Drugs. Circulation. 2018 Oct 23;138(17):1879-1896. doi: 10.1161/CIRCULATIONAHA.118.035455.
Lei M, Wu L, Terrar DA, Huang CL. The modernized classification of cardiac antiarrhythmic drugs: Its application to clinical practice. Heart Rhythm. 2025 Apr 3:S1547-5271(25)02300-8. doi: 10.1016/j.hrthm.2025.03.1997.
Merino JL et al. Practical Compendium of Antiarrhythmic Drugs: A Clinical Consensus Statement of the European Heart Rhythm Association of the ESC . EP Europace, euaf076, https://doi.org/10.1093/europace/euaf076