Novel antiarrhythmic agents with combined mode of action.

In spite of the accelerated evolution in antiarrhythmic drug research and design, the ideal antiarrhythmic compound has not yet emerged. Pure class III agents have not been clinically successful, mainly due to their torsadogenic side-effects. Combination of class III effect with class I, II or IV effects has given better therapeutic results, whilst combination of the various antiarrhythmic mechanisms within one molecule, rather than combination of drugs, seems to be an even more promising strategy. In this study, we briefly review the most frequently applied antiarrhythmic combinations, focusing primarily to those novel antiarrhythmics where class III effects are combined with class IV or class I actions within the same single molecule.