Anti-arrhythmic drugs are potentially toxic, so treatment requires careful selection, assessment of effectiveness and regular review.
Assess the need for treatment
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Many arrhythmias are benign and do not require specific treatment.
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Correct precipitating or causal factors where possible, including alcohol excess, myocardial ischaemia, hyperthyroidism, acidosis, hypokalaemia and hypomagnesaemia.
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When drug therapy is required, use as few drugs as possible.
Select and assess therapy
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In difficult cases, programmed electrical stimulation during an electrophysiological study may help identify the optimum therapy.
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For life-threatening arrhythmias, ensure that prophylactic treatment is effective; ambulatory monitoring and exercise testing may help assess this.