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Updated classification of anti-arrhythmic drugs

last modified Jan 28, 2019 03:00 PM

Prof Chris Huang from Cambridge and colleagues from Oxford and Beijing have published a comprehensive re-classification of anti-arrhythmic drugs in Circulation.

In the late 1960s, Miles Vaughan Williams (Oxford) introduced a novel classification of drugs used to treat cardiac arrhythmias. This scheme has been widely used around the world and has led to the development of new drugs that have saved countless lives.

Research findings over the past five decades have led to the need to revise the classification. The modernised Oxford classification augments Vaughan Williams’s original framework covering the actions of sodium, potassium and calcium ions and the effects on these of the nervous system (Class I-IV).

Novel categories now relate to altered heart rates (Class 0), mechanical stretch (Class V); intercellular electrical communication (Class IV) and longer term structural change and upstream cellular signaling (Class VII). The scheme then draws attention to multiple drug targets and actions and possible adverse, even pro-arrhythmic, effects.

This clarified classification of the actions and therapeutic applications of both established drugs and novel drugs under investigation will improve current and future treatment of cardiac arrhythmias. It will encourage the rational clinical use of available anti-arrhythmic drugs in relationship to their particular mechanisms of action, and will help in the identification and development of novel drugs relating their future clinical applications to their molecular mechanisms of action. 

This outcome from collaboration between the Cambridge and Oxford BHF Centres of Excellence commemorates and advances the landmark contributions of Miles Vaughan Williams to the physiology of the heart that began this quest nearly half a century ago on this centenary of his birth. It is likely that the new classification will have an enduring impact on cardiovascular medicine.

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