Contemporary use of antiarrhythmic drugs: practical messages for clinical cardiologists from the EHRA compendium

Abstract

Antiarrhythmic drugs remain a cornerstone of rhythm and rate control in patients with cardiac arrhythmias, despite major advances in catheter ablation and device therapy. The EHRA Practical Compendium of Antiarrhythmic Drugs and its European Heart Journal editorial summarize 10 key messages that help clinicians use these agents more safely and effectively. The ABC indications framework (Appropriate, Back-up, Complementary) positions antiarrhythmic drugs alongside ablation and devices. A practical update of the Vaughan–Williams classification, understanding electrophysiological dynamics and pharmacokinetics, arrhythmia-specific drug selection, systematic proarrhythmic risk assessment, and careful use in comorbidities and special populations are the core themes. This article summarizes these messages with a clinical focus, supports scenario-based decision-making, and provides adapted tables and figure references to facilitate implementation in daily practice.