This new classification, while encompassing, the historic, widely accepted, Vaughan Williams VW classification. Its extensive subsequent citations reflect its significant global impact on AAD understanding and clinical use. This prompted its recent further development into a practical, more clinically useful, framework in a newly published (2025) article in Heart Rhythm, the official journal of the Heart Rhythm Society (USA) (Heart Rhythm. 2025 Apr 3:S1547-5271).
Those major approaches advancing cardiac arrhythmia management have now been globally endorsed and recognized in international clinical guidelines for AAD management. This came in the latest Clinical Consensus Statement [Practical Compendium of Antiarrhythmic Drugs: Europace, 2025 Mar 30; euaf076] from the Task Force of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC). A panel of internationally recognized cardiology experts highlighted and adopted the modernized 2018 Oxford classification as an essential improvement over the classic VW system.
This noted that limitations in the clinical guidance of the original VW classification had prompt repeated modernization efforts. It then regarded the modernized Oxford AAD classification as the most comprehensive and clinically relevant revision to date. This updated scheme systematized a broad range of drug classes and subclasses. It placed these within two overarching categories: regulatory-approved, clinically used AADs (Classes 0, I–IV, and VII) and investigational new drugs under development (INDs; Classes V and VI). The former included existing off-label formulations (e.g ivabradine and ranolazine in Classes 0 and Id respectively). Figure 1 illustrates this stratification.
This evolution in AAD classification represents a major step advancing harmonization of therapeutic strategies and drug development across global healthcare systems. The Modernized Oxford AAD classification is here poised to become the standard reference in clinical cardiology for managing cardiac arrhythmias.
References:
Lei M, Wu L, Terrar DA, Huang CL. Modernized Classification of Cardiac Antiarrhythmic Drugs. Circulation. 2018 Oct 23;138(17):1879-1896. doi: 10.1161/CIRCULATIONAHA.118.035455.
Lei M, Wu L, Terrar DA, Huang CL. The modernized classification of cardiac antiarrhythmic drugs: Its application to clinical practice. Heart Rhythm. 2025 Apr 3:S1547-5271(25)02300-8. doi: 10.1016/j.hrthm.2025.03.1997.
Merino JL et al. Practical Compendium of Antiarrhythmic Drugs: A Clinical Consensus Statement of the European Heart Rhythm Association of the ESC . EP Europace, euaf076, https://doi.org/10.1093/europace/euaf076