Class IV drugs block the slow inward Ca++ current (L-type calcium channel) in cardiac tissue. The most pronounced electrophysiological effects are exerted on cardiac cells that depend on the Ca++ channel for initiating the action potential, such as those found in the sinoatrial and A-V nodes. The administration of class IV drugs slows conduction velocity and increases refractoriness in the A-V node, thereby reducing the ability of the A-V node to conduct rapid impulses to the ventricle. This action may terminate supraventricular tachycardias and can slow conduction during atrial flutter or fibrillation.
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