In a study of 12 patients, ranolazine reduced ICD shocks in otherwise medication-resistant VT/VF in 11 In MERLIN TIMI-36 (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes-Thrombolysis In Myocardial Infarction 36), ranolazine did not reduce SCD but did reduce VT in the first few days after a non-ST-segment In 1 RCT, high-risk ICD patients with ischemic or NICM were randomly assigned to ra- nolazine 1000 mg twice a day versus placebo.S5.1.5.2-9 High risk was defined as: 1) having a primary prevention CLINICAL STATEMENTS AND GUIDELINES Table 7. Pharmacological Characteristics of Available Antiarrhythmic Medications for Treating VA Antiarrhythmic Medication (Class) and Dose Uses in VA/SCA Target Electrophysiological Effects Pharmacological Characteristics Common Adverse Effects Acebutolol PO 200 1200 mg daily or up to 600 mg bid VT, PVCs Beta 1, Mild intrinsic sympathomimetic activity Sinus rate slowed AV nodal refractoriness increased Active metabolite t1/2 : pProlonged with renal impairment) Metab: H Excr: F 60%, U 40% Cardiac: Bradycardia, hypotension, HF, AVB Other: Dizziness, fatigue, anxiety, impotence, hyper/ hypoesthesia Amiodarone (III) IV: 300 mg bolus for VF/pulseless VT arrest; 150-mg bolus for stable VT; 1 mg/min x 6 h, then 0.5 mg/min x 18 h PO: 400 mg* q 8 to 12 h for 1 2 wk, then 300 400 mg daily; reduce dose to 200 mg daily if possible VT, VF, PVC, INa , ICa , IKr , IKs , Ito , Beta receptor, Alpha receptor receptor Sinus rate slowed QRS prolonged QTc prolonged AV nodal refractoriness increased; increased DFT : 26 107 d Metab: H Excr: F Cardiac: Hypotension, bradycardia, AVB, TdP, slows VT below programmed ICD detection rate, increases defibrillation threshold Other: Corneal microdeposits, thyroid abnormalities, ataxia, nausea, emesis, constipation, photosensitivity, skin discoloration, ataxia, dizziness, peripheral neuropathy, tremor, hepatitis, cirrhosis, pulmonary fibrosis or pneumonitis Atenolol (II) PO: 25 100 mg qd or bid VT, PVC, ARVC, LQTS Beta 1 Sinus rate slowed AV nodal refractoriness increased : 6 7 h (prolonged with renal impairment) Metab: H Excr: F 50%, U 40% Cardiac: Bradycardia, hypotension, HF, AVB Other: Dizziness, fatigue, depression, impotence Bisoprolol (II) PO: 2.5 10 mg once daily VT, PVC Beta 1 receptor Sinus rate slowed AV nodal refractoriness increased : 9 12 h Metab: H Excr: U Cardiac: Chest pain, bradycardia, AVB Other: Fatigue, insomnia, diarrhea Carvedilol (II) PO: 3.125 25 mg q VT, PVC Beta 1 and 2 receptors, Alpha Sinus rate slowed AV nodal refractoriness increased : 7 10 h Metab: H Excr: F Cardiac: Bradycardia, hypotension, AVB, edema, syncope Other: Hyperglycemia, dizziness, fatigue, diarrhea Diltiazem (IV) IV: 5 10 mg qd: 15 30 min Extended release: PO: VT specifically RVOT, idiopathic LVT ICa-L Sinus rate slowed PR prolonged AV nodal conduction slowed : Injection 2 5 h, immediate release 4.5 12 h, extended release 12 h, and severe hepatic impairment 14 16 h Metab: H Excr: U Cardiac: Hypotension, edema, HF, AVB, bradycardia, exacerbation of HFrEF Other: Headache, rash, constipation Esmolol (II) IV: 0.5 mg/kg bolus, VT Beta 1 receptor Sinus rate slowed AV nodal refractoriness increased : 9 min Metab: RBC esterases Excr: U Cardiac: Bradycardia, hypotension, HF, AVB Other: Dizziness, nausea Flecainide (IC) PO: 50 200 mg q 12 h VT, PVC (in the absence of structural heart disease). 