Disopyramide Mechanism of Action

Introduction

Disopyramide is a class IA antiarrhythmic medication used primarily for the treatment of certain types of cardiac arrhythmias, particularly ventricular and atrial arrhythmias. It works by affecting the electrical conduction in the heart, helping to stabilize abnormal heart rhythms.

Mechanism of Action

Disopyramide exerts its effects mainly by:

  1. Sodium Channel Blockade - It inhibits fast sodium channels in the cardiac myocytes, slowing phase 0 (depolarization) of the action potential. This results in:

    • Decreased conduction velocity.
    • Prolongation of the QRS complex.
  2. Prolongation of Action Potential Duration - By increasing the effective refractory period, it reduces the likelihood of reentry arrhythmias.

  3. Anticholinergic Effects - Unlike some other class IA drugs, disopyramide has significant anticholinergic properties, which can lead to side effects like dry mouth, constipation, and urinary retention.

  4. Negative Inotropic Effect - It reduces myocardial contractility, which may be problematic in patients with heart failure.

Clinical Considerations

  • Indications: Used for certain cases of atrial fibrillation, atrial flutter, and ventricular tachycardia.
  • Contraindications: Avoid in patients with heart failure due to its negative inotropic effect.
  • Side Effects: May include hypotension, anticholinergic symptoms, and proarrhythmic effects.

Conclusion

Disopyramide is an effective antiarrhythmic drug with notable sodium channel-blocking and anticholinergic properties. However, it requires careful monitoring due to its potential side effects and contraindications.

Source recommendations

1. American Heart Association Guidelines for the Management of Atrial Fibrillation

  1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
  2. https://professional.heart.org/en/science-news/2023-acc-aha-accp-hrs-guideline-for-the-diagnosis-and-management-of-atrial-fibrillation
  3. https://www.heart.org/en/health-topics/atrial-fibrillation
  4. https://pubmed.ncbi.nlm.nih.gov/38033089/
  5. https://www.heart.org/en/health-topics/atrial-fibrillation/treatment-and-prevention-of-atrial-fibrillation/treatment-options-of-atrial-fibrillation-afib-or-af

2. European Society of Cardiology Guidelines for the Management of Atrial Fibrillation

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Atrial-Fibrillation
  2. https://academic.oup.com/eurheartj/article/45/36/3314/7738779
  3. https://www.escardio.org/static-file/Escardio/Guidelines/Documents/ehaa612.pdf
  4. https://academic.oup.com/eurheartj/article/42/5/373/5899003
  5. https://pubmed.ncbi.nlm.nih.gov/32860505/

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