This review is devoted to the modern use of antiarrhythmic drugs (AADs) in cardiac arrhythmias. The Practical Compendium of AADs, developed by the European Heart Rhythm Association (EHRA) [2025], analyzes the complex field of AADs, explaining their mechanisms of action, efficacy, and safety profiles in patients with arrhythmias.The main mechanisms of arrhythmias, aspects of their onset, maintenance, and termination are considered. Current data on the mechanisms of cardiac rhythm disturbances — excitation circulation (or re-entry) and abnormalities in excitation generation in the form of trigger activity — are summarized. One of the key aspects of the new paradigm of antiarrhythmic therapy is the search for and action on the «vulnerable» parameters of arrhythmias. Information on the remodeling of ion channel properties is provided. The presented classifications of AADs summarize current views on their electrophysiological actions, allow for the existence of multiple targets/actions of drugs, as well as side effects and proarrhythmic effects, which aids in the understanding and clinical treatment of cardiac arrhythmias.
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