EP medications, explained.

A direct oral anticoagulant (DOAC) we use to lower stroke risk in atrial fibrillation and to treat or prevent blood clots in the legs and lungs. Taken twice daily, no routine blood testing required.

A direct oral anticoagulant (DOAC) that blocks thrombin to reduce stroke risk in atrial fibrillation and to treat or prevent venous clots. Taken twice daily, and notable for having a specific reversal agent.

A direct oral anticoagulant (DOAC) used for stroke prevention in atrial fibrillation and for treating or preventing clots in the legs and lungs. Taken once daily, often with food.

The original oral anticoagulant — still essential for patients with mechanical heart valves and certain other conditions. Requires regular blood testing (INR) and attention to diet and interactions.

The most effective antiarrhythmic medication we have — but also the one with the most long-term side effects. We use it carefully, often short-term, and monitor several organs while patients are on it.

An antiarrhythmic designed as a safer cousin of amiodarone — same multichannel mechanism but without the iodine, and without most of the organ toxicities. We use it to maintain normal rhythm in selected patients with paroxysmal AF, but it is less effective than amiodarone and has its own restrictions.

Two Class 1c antiarrhythmic medications we use to keep the heart in normal rhythm, mostly for atrial fibrillation and SVT. They are clean, effective, and well-tolerated — but only safe in hearts without significant underlying disease.

A rhythm-control medication that combines beta-blocker effects with a longer-acting Class III action. We use it for atrial fibrillation and certain ventricular arrhythmias, and we start it in the hospital so we can watch the QT interval safely.

A pure Class III antiarrhythmic we use almost exclusively for atrial fibrillation and flutter. It is effective and clean — but it must be started in the hospital over three days because of the careful QT monitoring it requires.

A family of medications that blunt the effect of adrenaline on the heart. We use them for rate control in AF and flutter, symptom control in SVT, and as a cornerstone for inherited arrhythmias like long QT syndrome.

Two related medications we use for rate control in atrial fibrillation and flutter, and for preventing and terminating SVT. They work by slowing the AV node — the electrical relay between the upper and lower chambers.

Two medications we use to support the circulation in patients with vasovagal syncope, POTS, and other forms of orthostatic intolerance. They work in different ways — midodrine tightens blood vessels, fludrocortisone expands plasma volume — and we often use them together.