TAILIEUCHUNG - Handbook of Experimental Pharmacology - Part 4

Thuốc chống loạn nhịp gây giảm natri khối kênh vào lớp học của tôi, và tiếp tục chia nhỏ bởi động lực phục hồi từ khối (Harrison 1985). Ví dụ, một số lớp Ib thuốc chống loạn nhịp thường được sử dụng trong điều trị và trong các | 102 . Glaaser . Clancy typically reside in closed and available resting states that represent a nonconducting conformation. Depolarization results in activation of the voltage sensors and channel opening allowing for ion passage. Subsequent to channel activation channels enter inactivated states that are non-conducting and refractory. Repolarization is required to alleviate inactivation with isoformspecific time and voltage dependence. 2 Antiarrhythmic Classification The Singh-Vaughan Williams classification system is the most widely used and segregates antiarrhythmics into one of four classes based on their effects on the cardiac action potential Vaughan Williams 1989 . Antiarrhythmic drugs that cause sodium channel block fall into class I and are further subdivided by kinetics of recovery from block Harrison 1985 . For example several class Ib antiarrhythmic drugs commonly used therapeutically and in laboratory studies lidocaine and mexiletine are characterized by tonic and use-dependent block UDB and fast recovery from drug block 1 s . Class la antiarrhythmics include procainamide and quinidine and have intermediate kinetics of recovery from drug block 1-10 s while class Ic antiarrhythmics such as flecainide exhibit predominantly UDB and have slow kinetics of recovery from block 10 s . This classification system has proved useful in its simplicity however many drugs exhibit multiple electrophysiological actions and as a result fall into more than one class Roden 1990 . Moreover drugs within the same class may result in vastly different clinical responses. In response to these shortcomings the Sicilian Gambit proposed an alternate approach whereby the arrhythmia is diagnosed and an attempt is made to identify the vulnerable parameter . the electrophysiological component most susceptible to intervention that will terminate or suppress the arrhythmia with minimal toxicity Task Force of the Working Group on Arrhythmias of the European Society of Cardiology

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