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In the late 1960s Miles Vaughan Williams, a member of the staff in the Oxford Department of Pharmacology and Fellow of Hertford College (1955-85), introduced a novel classification of drugs used to treat cardiac arrhythmias. This scheme has been very widely used around the world and has led to the development of new drugs that have saved countless lives. Our understanding of the control of cardiac rhythm has developed in that time and a group of cardiovascular scientists from Oxford, Cambridge and Beijing led by Associate Professor Ming Lei decided that the time was ripe to modernise the classification and to celebrate the centenary of the birth of Vaughan Williams.

Cardian rhythm

Together they have now published a comprehensive modern classification, based upon the original version, in the leading journal ‘Circulation’.

Findings over the past 5 decades from studies of different molecular drug targets, their mechanisms of action, and consequent clinical effects have led to the need to revise the classification. The modernised Oxford classification augments Vaughan Williams’s original framework covering the actions of sodium, potassium and calcium ions and the effects on these of the nervous system (Class I-IV). Novel categories now relate to altered heart rates (Class 0), mechanical stretch (Class V); intercellular electrical communication (Class IV) and longer term structural change (Class VII). The scheme then draws attention to multiple drug targets and actions and possible adverse, even pro-arrhythmic, effects.

This clarified classification of both the actions and therapeutic applications of both established drugs and novel drugs under investigation will improve current and future treatment of cardiac arrhythmias. It will encourage a rational clinical use of existing available anti-arrhythmic drugs in relationship to their particular mechanisms of action. It will aid identification and development of novel drugs relating their future clinical applications to their molecular mechanisms of action.  

The classification commemorates and advances the landmark contributions of Miles Vaughan Williams (https://en.wikipedia.org/wiki/Miles_Vaughan_Williams) to the physiology of the heart that began this quest nearly half a century ago on this centenary of his birth. It is likely that the new classification will have an enduring impact on cardiological medicine.

See the text of the paper here:

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.118.035455

https://www.ahajournals.org/doi/suppl/10.1161/circulationaha.118.035455.