All antiarrhythmic drugs can also cause arrhythmia; they should be used with care and ideally only following advice from a specialist. Such proar-rhythmic effects are most commonly seen with drugs that prolong the QT interval or QRS complex of the ECG; hypokalaemia aggravates the danger. Quinidine may cause tachyarrhythmias in an estimated 4-6% of patients. A probable proarrhythmic effect of flecainide resulting in a doubling of mortality was revealed by the Cardiac Arrhythmia Suppression Trial (CAST) (see p. 502).
Digoxin can induce a variety of brady- and tachyarrhythmias (see above).
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